Biocompatibility of the Oxygenator on Pulsatile Flow by Electron Microscope

ABSTRACT Introduction: Extracorporeal perfusion flow type requires further investigation. The aim of this study is to compare the effects of pulsatile and nonpulsatile flow on oxygenator fibers that were analyzed by scanning electron microscope (SEM) and to extensively study patients' coagulation profiles, inflammatory markers, and functional blood tests. Methods: Twelve patients who had open heart surgery were randomly divided into two groups; the nonpulsatile flow (group NP, six patients) and pulsatile flow (group P, six patients) groups. Both superficial view and axial sections of the oxygenator fiber samples were examined under SEM to compare the thickness of absorbed blood proteins and amount of blood cells on the surface of oxygenators. Platelet count, coagulation profile, and inflammatory predictors were also studied from the blood samples. Results: Fibrinogen levels after cardiopulmonary bypass were significantly lower in group NP (group P, 2.57±2.78 g/L; group NP; 2.39±0.70 g/L, P=0.03). Inflammatory biomarkers such as C-reactive protein, interleukin (IL)-6, IL-12, apelin, S100β, and tumor necrosis factor alpha were comparable in both groups. Axial sections of the oxygenator fiber samples had a mean thickness of 45.2 µm and 46.5 µm in groups P and NP, respectively, and this difference is statistically significant (P=0.006). Superficial view of the fiber samples showed obviously lower platelet, leukocyte, and erythrocyte levels in group P. Conclusion: Our study demonstrated that both cellular elements and protein adsorption on oxygenator fibers are lower in the group P than in the group NP. Pulsatile perfusion has better biocompatibility on extracorporeal circulation when analyzed by SEM technique.

Caliber-persistent labial artery: report of 3 cases

Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

Finite Element Analysis and in vitro Hemodynamic Testing of Polyester Textile Valves with Nitinol Wires / 医用生物力学

Objective To study mechanical properties of polyethylene terephthalate (PET)-based textile valves woven with nickel-titanium (NiTi) wires by finite element method, and combined with in vitro hemodynamic testing, to analyze the effect of wire quantity and woven position on hemodynamic performance of PET textile valve. Methods The three-dimensional (3D) geometric models of PET valves without wires and models of PET valves with wires by different numbers and distributions in radial direction were constructed using modeling software. Material properties of PET valves and wires were given based on the literature and experimental data. The transvalvular pressure difference curves of PET valves obtained from in vitro pulsatile flow experiments were used as boundary conditions. Stress distributions of the valve during peak systole and diastole were studied by finite element analysis software. Hydrodynamic performance of the valve with wires was evaluated by in vitro pulsatile flow experiments. ResultsThe finite element analysis results showed that the radially woven NiTi wires could enhance support for the PET textile valve, and support force and area of the valve in belly region of the valve leaflet with evenly distributed metal wires increased with the number of metal wires. The situation of support force was similar for silk distributions on both sides of the belly. The weaving of wires reduced stress concentration on the PET textile valve to a certain extent. The pulsatile flow experiment results showed that the stability of opening and closing shapes, effective opening area (EOA), regurgitation fraction (RF) and transvalvular pressure differences for two kinds of the PET valves with woven wires were better than those of the PET valves without wires. Conclusions Weaving metal wires in radial direction of the PET textile valve can effectively reduce stress concentrations on the PET textile valve during the cardiac cycle, and reduce tearing possibility of the valve leaflet. The woven metal wires can improve opening and closing stability of PET textile valve in in vitro hydrodynamic test, increase EOA and reduce RF and transvalvular pressure difference of the PET valve.

Two Cases of Idiopathic Pulsatile Tinnitus Successfully Treated with Kampo Medicine / 日本東洋医学雑誌

In cases of pulsatile tinnitus, the presence of organic disease should be suspected, and many of them can be treated once the cause is identified. However, there are idiopathic cases in which the cause cannot be identified, and there is no established treatment for them. Here, we report 2 cases in which Kampo medicine was effective for idiopathic pulsatile tinnitus. Case 1 was a 50-year-old man. He had been stressed for half a year due to the change of job title in his workplace, and he had left pulsatile tinnitus a month ago. We administered saikokaryukotsuboreito, and his tinnitus disappeared in a week. Case 2 was a 30-year-old woman. She gave birth 4 months ago, and after giving birth, she had less sleep and was tired and stressed. She started to notice right pulsatile tinnitus and dizziness from a month ago. We administered nyoshinsan, and her tinnitus and dizziness disappeared in 2 months. In both cases, they were aware of hot flashed on their face as a symptom of qi counterflow, and Kampo treatment improved the symptom together with pulsatile tinnitus. It is possible that blood flow in the head increased with qi counterflow, causing relative stenosis of the blood vessels in the head, leading to turbulence in the lumen of the blood vessels, and hearing pulsatile tinnitus.

Feasibility of transesophageal echocardiography-guided transthoracic micro-incisions for the treatment of aortic dissection / 中国基层医药

Objective:To investigate the feasibility of transesophageal echocardiography (TEE)-guided transthoracic micro-incisions for the treatment of aortic dissection.Methods:Ten patients with aortic dissection who received TEE before surgery between March 2017 and March 2019 in Zhejiang Provincial Hospital of Chinese Medicine, China were included in this study. They were divided into group A (involving the aorta, n = 5) and group B (aortic arch ulcer, n = 5). Diagnosis before and after surgery was analyzed in each group. Whether guide sheath tube and guide wire rapidly entered the interlayer during the surgery was assessed. In addition, the stability and position of the occluder device and its effect on local blood flow were assessed. Results:TEE findings revealed that occlusion treatment was effective and TEE-guided transthoracic micro-incisions successfully occluded the breaks of the aortic dissection. In group A, the occluded breaks of the aortic dissection disappeared, and thrombi formed in the false lumen. Blood flow velocity decreased from 230 cm/s to 120 cm/s. In group B, aortic wall was tightly bounded to the occluder device and the breaks disappeared. The velocity of the blood flow in the arch of the aorta was 120 cm/s. The occluder device was stable before and after occlusion. It had no effect on the velocity of local blood flow. At 40 days after surgery, the position of the occluder was not deviated.Conclusion:TEE before surgery for aortic dissection can effectively assess the injury degree and avoid missed diagnosis. TEE can guide the placement of the occluder device during the surgery. TEE can also help accurately assess the surgical outcomes.

Varizes pulsáteis simulando aneurisma de artéria femoral: relato de caso / Pulsatile varicose veins simulating femoral artery aneurysm: case report

Resumo A regurgitação tricúspide severa é citada como fator associado ao desenvolvimento ou à recidiva de varizes em membros inferiores as quais podem, retrogradamente, apresentar um fluxo pulsátil. O diagnóstico etiológico diferencial desse achado ultrassonográfico deve ser feito com a pesquisa de fístulas arteriovenosas, tendo em vista as diferentes formas de tratamento. Dada a complexidade do estado geral dos pacientes com regurgitação tricúspide, a escolha do tratamento das varizes pulsáteis deve ser individualizada, fruto de uma avaliação multidisciplinar. Fazem parte do arsenal terapêutico todas as técnicas habitualmente empregadas no tratamento de varizes, bem como a associações entre elas a serem escolhidas levando-se em conta a gravidade das manifestações clínicas e o risco cardiovascular envolvido. Relatamos um caso de varizes pulsáteis secundárias a regurgitação tricúspide, diagnosticado durante a suspeita primária de aneurisma de artéria femoral em paciente de 73 anos, com a classificação clínica da doença venosa (CEAP) 4a, oligossintomática, tratada com medidas posturais e elastocompressão.

Abstract Severe tricuspid regurgitation is mentioned as a factor associated with development or recurrence of varicose veins in the lower limbs and may present with retrograde pulsatile flow. Differential etiological diagnosis of this ultrasound finding must include investigation of arteriovenous fistulas, since the treatment methods are different. Given the complexity of the general condition of patients with tricuspid regurgitation, treatment for pulsatile varices should be chosen on a case-by-case basis after multidisciplinary evaluation. All of the techniques commonly used to treat varicose veins are part of the therapeutic arsenal, as well as combinations of them, taking into account the severity of clinical manifestations and the cardiovascular risk involved. We report a case of pulsatile varices secondary to tricuspid regurgitation diagnosed when investigating a primary suspicion of femoral artery aneurysm in a 73-year-old patient, CEAP 4a, oligosymptomatic, who was treated with postural measures and elastic compression.

Pulsatile varicose veins: an uncommon presentation of a common condition / Varizes pulsáteis: uma apresentação incomum de uma condição comum

Abstract Varicose veins of the lower limbs are common. However, pulsatile varicose veins are unusual. They could be an indicator of a sinister underlying pathology, such as severe cardiac dysfunction. It is easy to miss these rare cases during clinical workup, which can result in futile treatment with potentially dangerous consequences. In this report, we describe 2 cases of pulsatile varicose veins that highlight different etiologies and management strategies for this condition.

Resumo Varizes dos membros inferiores são comuns. Entretanto, varizes pulsáteis são raras, podendo ser indicadoras de uma patologia subjacente sombria como disfunção cardíaca grave. É fácil deixar passar esses casos raros durante exames clínicos, o que pode resultar em tratamento fútil com consequências potencialmente perigosas. Neste relato, descrevemos dois casos de varizes pulsáteis que evidenciam as diferentes etiologias e estratégias de manejo para essa condição.

Etiología del acúfeno pulsátil. Caso clínico / Etiology of pulsatile tinnitus. Case report

Resumen El acúfeno es un síntoma relativamente frecuente en una consulta de otorrinolaringología. Se han descrito interacciones en las células ciliadas externas o internas, desequilibrios en el balance de las fibras aferentes y fenómenos de reorganización cortical tras lesiones periféricas que están involucrados en un 90%-95% de las causas del acúfeno. El restante 5%-10% está constituido por un tipo de acúfenos llamados objetivos, que no comparten estos mecanismos fisiopatológicos, sino que se originan en alguna estructura del organismo generalmente ajena a la vía auditiva y estimulan el aparato auditivo igual que lo haría un sonido del exterior. Presentamos el caso de un varón de 52 años remitido al Servicio de Otorrinolaringología de nuestro hospital por acúfeno pulsátil de meses de evolución, sin asociar hipoacusia, ni vértigo, ni otra sintomatología.

Abstract Tinnitus is a relatively frequent symptom in an otolaryngology consultation. Interactions in external or internal hair cells, imbalances in the afferent fiber balance and cortical reorganization phenomena after peripheral injuries have been described in 90%-95% of the causes of tinnitus. The remaining 5%-10% is comprised of a type of tinnitus called objective, which do not share these pathophysiological mechanisms, but originate from some structure of the body generally external to the auditory pathway and stimulate the auditory apparatus just as a sound from the exterior. We present the case of a 52-year-old man referred to the Otolaryngology service at our hospital for pulsatile tinnitus of months of evolution, with no hearing loss, vertigo, or other symptoms associated.

Preparation and Drug Release Mechanism of Time Controlled Explosive Pulsatile Tablets with Ethylcellulose Coating

Background The time rhythm of human body is associated with the occurrence and development of manydiseases, and it also affects the efficacy and pharmacokinetic characteristics of the corresponding therapeuticdrugs. Therefore, the chronopharmacological drug delivery system has potential applications. Aim In this work, it is proposed to develop a kind of pulsatile release tablet of simple structure and preparingprocess, thus to provide an alternative drug delivery system for therapeutic agents used in treatment of diseasesof typical onset biorhythm at period inconvenient to take drug.Methods Metoprolol tartrate (MT), a drug widely used clinically to treat cardiovascular diseases was selected asa model drug for developing pulsatile tablets of time-controlled explosive system (TES). The MT pulsatile tabletswere ethyl cellulose (EC) coating tablets produced by pan coating process, and the core tablets were preparedby direct compression. The formulation and process was optimized by single factor test and orthogonal design.Also, the pulsatile release mechanism of the tablets was discussed through investigating the water absorptionand swelling capacity of tablets as well as the mechanical properties of EC free film.Results A kind of pulsatile tablets of MT were developed with a drug release lag time around 7 h and a fastrelease of drug after lag time. When the swelling force of core tablet caused by water uptake was high enoughover the tensile strength of EC coating film, the MT pulsatile tablets demonstrated a shell-type exploding rupturedue to the great rigidity and weak flexibility of EC film, and then a fast pulsatile release of drug was observed.Both the swelling capacity of core tablet and the thickness of coating film together controlled the lag time of drugrelease. The lag time showed a good linear relationship with the thickness of coating film (r = 0.9984, P < 0.01).The sort and amount of fillers and disintegrants dominated the release behaviour after lag time.Conclusion The developed MT pulsatile tablets can exert a timely release of drug before peak onset period ofhypertension and angina pectoris early in the morning after drug taking around 22:00 P.M the night before. Thegood linear relationship between lag time and coating thickness enabled the pulsatile tablets to be used fordelivery of other therapeutic agents of similar chronotherapy demand by adjusting the coating thickness toachieve the appropriate lag time of drug release to match the different high attack rhythm of the exact diseases.

Drug Release and Pharmacokinetics Behavior of a Simple Ethylcellulose Coating Pulsatile Tablet of Time-controlled Explosive System

Background The time rhythm of human body is associated with the occurrence and development of manydiseases. Kinds of diseases of particular onset biorhythm provided the room for the development ofchronopharmacological drug delivery systems.Aim In this work, the drug release and pharmacokinetics behavior of metoprolol tartrate (MT) pulsatile tabletdeveloped in our lab was investigated to figure out its feasibility of convenient drug taking to exert effectivechronotherapy for cardiovascular diseases like hypertension and angina pectoris.Methods The in vitro release behavior of MT pulsatile tablets was investigated by using basket method. Theappearance and morphology of MT pulsatile tablets during drug release was observed by naked eye and scanning electronic microscope, respectively. In vivo pharmacokinetics performance was studied in NewZealand rabbits.Results The lag time of MT pulsatile tablets was approximately 7 h in vitro, and a fast release was observedthereafter, with more than 90% releasing within 10 min. The pharmacokinetics study in rabbits demonstrateda perfect consistence in the absorption lag time of 7.04 ± 0.29 h in vivo. Compared with the marketedconventional tablet, the MT pulsatile tablet showed a bioequivalence in absorption extent with a relativebioavailability of 110.04%, but not in absorption rate.Conclusion The designed lag time of 7 hours enabled the MT pulsatile tablets to achieve effectivechronotherapy for cardiovascular diseases like hypertension and angina pectoris with a high attack rhythmaround 4:00-6:00 A.M by giving medicine conveniently around 22:00 P.M. the night before.

Gestantes con índice de pulsatilidad alterado en ecografía Doppler / Pregnant women with altered pulsatility index in Doppler echography

Introducción: La ecografía Doppler de las arterias uterinas es una técnica propuesta para predecir el riesgo de preeclampsia, retardo del crecimiento intrauterino y otras alteraciones perinatales adversas. Objetivos: Determinar la frecuencia de gestantes con alteración en las arterias uterinas durante el primer trimestre e identificar la presencia de preeclampsia/eclampsia, así como sus principales características clínicas. Métodos: Se efectuó un estudio descriptivo y longitudinal de 168 gestantes en el primer trimestre de embarazo, pertenecientes al municipio de Tercer Frente en Santiago de Cuba, evaluadas en una pesquisa de Genética realizada en el Policlínico Docente Cruce de los Baños, de abril a noviembre de 2018. A todas se les realizó ecografía Doppler para calcular el índice de pulsatilidad de las arterias uterinas. Resultados: En la casuística, 16 pacientes presentaron alterado el índice de pulsatilidad y, de ellas, solo en 3 se desarrolló preeclampsia, para 18,7 %; la edad promedio en estas últimas fue de 29 años y 2 eran nulíparas (66,6 %). Respecto al índice de pulsatilidad, el promedio fue de 2,5. Conclusiones: Se mantuvo un estrecho seguimiento, hasta el parto, de las pacientes con resultados patológicos, y se destacó la importancia de estudiar el índice de pulsatilidad de las arterias uterinas durante el primer trimestre del embarazo, sobre todo en las nulíparas.

Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized.

Application of pulsatile lavage in wound healing of diabetic foot ulcer patients / 中国实用护理杂志

Objective@#To explore the effect of pulsatile lavage on wound healing in diabetic foot ulcer patients.@*Methods@#The random number table method was used to divide 86 patients of diabetic foot ulcers into two groups with 43 patients in each group. The control group disinfected and cleaned the wound by routine methods, while the experimental group received closed pulse irrigation with sewage collection unit. The two groups were debridement, dressing selection and wound dressing in a unified way. The frequency of dressing change, time of dressing change, efficacy, cost of dressing changes, score of wound pain and wound healing were observed.@*Results@#The frequency of dressing change, dressing change time, wound healing time and total effective rate of the experimental group were (10.42±1.92) times, (12.19±2.37) min, (32.53±6.91) d and 86.04% (37/43), respectively, while those of the control group were (19.47±3.13) times, (21.65±3.99) min, (43.17±13.72) d and 51.16% (22/43), with statistically significant differences (t values were 4.545-16.127, χ2 value was 13.214, all P < 0.01). However, the cost of dressing change in the experimental group was (3 278.78±220.92) yuan, and that in the control group was (3 195.75±206.54) yuan. There was no significant difference between the two groups (t value was -1.814, P > 0.05). The pain scores were (1.47±1.09), (0.57±0.72), (0.06±0.23), (0.003±0.01) points in the experimental group at the 2nd week,the 4th week,the 6th week and the 8th week after intervention, and they were (3.83±1.16), (2.73±1.41), (1.92±1.06), (1.43±0.70) points respectively in the control group, the differences were statistically significant (Ftime=390.663, Fintergroup=76.011, Finteraction=4.210, all P < 0.01). The wound healing rates were (49.34±9.34)%, (86.26±13.33)%, (95.01±8.56)%, (97.28±3.62)% respectively in the experimental group in the 2nd week,the 4th week,the 6th week and the 8th week after intervention,while in the control group they were (26.64±5.19)%, (50.37±10.53)%, (64.84±12.27)% and (72.04±12.96)%. The differences between the two groups were statistically significant (Ftime=354.487, Fintergroup= 921.230, Finteraction =23.154, all P < 0.01).@*Conclusions@#Pulsatile lavage can effectively clean the wound, reduce the frequency of dressing change, shorten the time of dressing change and wound healing, reduce the wound pain, improve the wound healing rate of diabetic foot ulcers, and did not increase the economic burden of patients, which was worthy of clinical application.

Formulation And In Vivo Evaluation Of Chronomodulated Drug Delivery Of Nimodipine

Chronotherapy has been emerging as a novel technology in the field of pharmaceutical research. Delivery of drugs with respect to the circadian rhythm has gained greater importance in the diseases such as diabetes, asthma and hypertension in producing maximum therapeutic action. Present study focus on the formulation and evaluation of Nimodipine pulsatile release tablets with the incorporation of Eudragit pH sensitive polymers used for the chronotherapy of hypertension. Pharmacologically Nimodipine is an anti-hypertensive agent that acts by blocking the L and N-type calcium channels. Evaluation parameters for Nimodipine tablets included friability, drug content, bulk and tapped density, angle of repose and Carr’s index and drug release in vitro and in vivo.

Carotid-artery cochlear dehiscence

Changes in course of the internal carotid artery (ICA) are uncommon, and dehiscence of the carotid canal with cochlea may occur. A 48-year-old female individual with pulsatile tinnitus. No other otologic symptoms observed. Otolaryngologic examination and audiometric test with normal results. Computed tomography (CT) scan of the mastoid bones showed dehiscence of cochlea with ICA on the right side. An option for monitored observation was made after analysis of the risks and undefined results of surgery. Patient maintained clinical and audiometric profile. Carotid-artery cochlear dehiscence is a condition that must be known, remembered and investigated, because it may mimic other otologic pathologies. Knowledge about it prevents serious complications that can be difficult to reverse.

An Aortic Root Abscess Presenting as a Suprasternal Pulsatile Mass / 대한흉부외과학회지

Prosthetic valve endocarditis with aortic root abscess is a serious condition requiring urgent surgical intervention. We present a case caused by an infected Bentall mechanical valve conduit after cardiac surgery in a patient who was referred for a suprasternal pulsatile mass. The patient also had 1 episode of sentinel haemorrhage.

Less Pulsatile Levodopa Therapy (6 Doses Daily) Is Associated with a Reduced Incidence of Dyskinesia

OBJECTIVE: To evaluate whether less pulsatile levodopa therapy (LPT) can reduce the development of levodopa-induced dyskinesia (LID). METHODS: This is a retrospective cohort study of patients with Parkinson’s disease at the movement disorders clinic of Medstar Washington Hospital Center. The study was not blinded or randomized. Patients were seen between August 2002 and August 2018. During these years, we treated patients with less pulsatile (6 doses daily) levodopa treatment to reduce LID. Occurrence of LID was recorded. RESULTS: Ninety-five patients with Parkinson’s disease taking levodopa were divided into two groups: 1) patients who were initially managed on LPT or who switched from traditional therapy (TT) (n = 61) (mean disease duration: 7.7 ± 4.8 years, mean levodopa duration: 5.6 ± 4.5 years and mean observation time: 4.3 ± 3.4 years), and 2) patients on TT throughout the observation period or until they developed dyskinesia (n = 34) (mean disease duration: 8.3 ± 3.8 years, mean levodopa duration: 6.2 ± 4.2 years and mean observation time: 4.1 ± 3.4 years). Three of the 61 LPT patients developed dyskinesia during the observation period. One of the patients developed dyskinesia after being switched to pulsatile doses by another doctor. In the other two, dyskinesia was minimal. In contrast to this 4.9% cumulative incidence, dyskinesia occurred in 50% (17/34) of TT patients, an incidence similar to that in published data (p < 0.001). CONCLUSION: Less pulsatile levodopa with 6 daily doses was associated with a low incidence of LID. Further study of this method of treatment is warranted.

Máquina de perfusão versus armazenamento estático na preservação renal de doadores com morte encefálica: revisão sistemática e metanálise / Machine perfusion versus cold storage in renal preservation of deceased donors with brain death: systematic review and meta-analysis

RESUMO Com a utilização crescente da máquina de perfusão no transplante renal, tem sido constatado que a isquemia dinâmica correlaciona-se à melhora da preservação orgânica. Nesse contexto, realizamos uma revisão sistemática que procurou avaliar a eficácia do uso de máquina de perfusão portátil (LifePort Kidney Transporter Machine®), utilizada no Brasil, comparada ao armazenamento estático, no que tange à função retardada do transplante renal de doadores com morte encefálica. Foi efetuada pesquisa bibliográfica, nas bases LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, SciELO, além de busca manual no Google acadêmico. A revisão sistemática, finalizada em abril 2017, foi constituída somente por ensaios clínicos randomizados. Para metanálise, foram avaliadas Razão de Risco e Razão de Chance. Foram identificados 86 documentos e selecionados, ao final, dois artigos com critérios de elegibilidade para metanálise, de grupos europeus e brasileiros. Nestes, 374 rins foram alocados para a máquina de perfusão, e igual número para o armazenamento estático. A função retardada do enxerto foi constatada em 84 e 110 pacientes, respectivamente. Na metanálise, foram obtidas uma Razão de Risco de 0,7568 (p=0,0151) e uma Razão de Chance de 0,6665 (p=0,0225), ambas com intervalo de confiança de 95%. A máquina de perfusão reduziu a incidência de função retardada do enxerto de doadores com morte encefálica.

ABSTRACT With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed a systematic review that aimed to evaluate the efficacy of the portable machine perfusion (LifePort Kidney Transporter Machine®), used in Brazil, compared to cold storage, regarding the delayed graft function of deceased donors with brain death. Literature search was carried out in LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, and SciELO, as well as in Google Scholar manually. The systematic review consisted only of randomized clinical trials. For meta-analysis, relative risk and odds ratio were evaluated. Eighty-six documents were identified and two papers from European and Brazilian groups were selected at the end, with eligibility criteria for meta-analysis. In these, 374 kidneys were assigned to machine perfusion and 374 kidneys were assigned to cold storage. Delayed graft function was observed in 84 and 110 patients, respectively. In meta-analysis, a risk ratio of 0.7568 (p=0.0151) and an odds ratio of 0.6665 (p=0.0225) were obtained, both with a 95% confidence interval. Machine perfusion reduced the incidence of delayed graft function of deceased donors with brain death.

Experimental Study on a Novel Electromagnetic Pulsatile Blood Pump / 医用生物力学

Objective To explore the power output and blood compatibility of a novel electromagnetic pulsatile blood pump. Methods First, a theoretical model was established to analyze the driving force of the blood pump, and the experimental driving voltage satisfying the conditions was calculated based on this model. Then, the output flow rate, output pressure characteristics and hemolysis performance of the new blood pump in vitro were preliminarily analyzed by simulated circulation experiments. Results The experimental result showed that when the pump load was 73-5 mmHg (9-78 kPa, 1 mmHg=0-133 kPa), the driving voltage was 35 V and the pulsation frequency was 75 beats/min, the flow rate of the pump was 3-18 L/min, producing high, low and average pressure of 132, 66, 98 mmHg (17-56, 8-78, 13-03 kPa), and the normalized index of haematolysis (NIH) in vitro was (0-049 15+0-003 75) mg/dL. Conclusions The new pulsatile blood pump can satisfy the clinical requirements for perfusion of isolated organs and short-term assistance of cardiopulmonary bypass, which is of great significance to the development of cardiopulmonary bypass blood pump.

An in vitro Experiment on Relationship Between Pulsatile Tinnitus and Temporal Bone Pneumatization Grade / 医用生物力学

Objective To study the relationship between pulsatile tinnitus and temporal bone pneumatization grade. Methods Through the in vitro experiment, the generation and transmission pathways of the venous sound were simulated. The sound signals at the position of eardrum were recorded and analyzed. Results In case of cortical plate dehiscence, the high pressure and pulse-synchronous venous sounds were received at eardrum. The highest sound pressure occurred in the normal pneumatization case. In case of cortical plate intactness, the non-pulsatile venous sounds with pressure close to the background control sound were received at eardrum. Temporal bone air cells (TBAC) with different pneumatization grades would transmit venous sound in different frequency ranges. Conclusions Normal pneumatization TBAC exhibited the highest amplification on venous sound, while hypopneumatization TBAC exhibited the lowest amplification on venous sound. The pneumatization grade of TBAC is neither the sufficient nor essential condition of pathogenic venous sound, while the cortical plate dehiscence is the sufficient or necessary condition of pathogenic venous sound.

Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist

The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.