Effect of pump prime on acidosis, strong-ion-difference and unmeasured ions during cardiopulmonary bypass.

We tested the hypothesis that a cardiopulmonary bypass prime with lactate would be associated with less acidosis than a prime with only chloride anions because of differences in the measured strong-ion-difference. We randomised 20 patients to a 1500 ml bypass prime with either a chloride-only solution (Ringer's Injection; anions: chloride 152 mmol/l) or a lactated solution (Hartmann's solution; anions: chloride 109 mmol/l, lactate 29 mmol/l). Arterial blood was sampled before bypass and then two, five, 15 and 30 minutes after initiating bypass. We used repeated measures analysis of variance to compare groups. In both groups, the base-excess and measured strong-ion-difference decreased markedly from baseline after two minutes of bypass. The chloride-only group had greater acidosis with lower base-excess and pH (P < 0.05), greatest after five minutes of bypass (C5). Contrary to our hypothesis, however, the difference between the groups was not due to a difference in the measured strong-ion-difference, P = 0.88. At C5 when the difference in standard base-excess between the groups was greatest, 1.9 mmol/l (95% confidence interval: 0.1 to 3.6 mmol/l, P < 0.05), the difference in the measured strong-ion-difference was only 0.2 mmol/l (95% confidence interval: -2.4 to 2.7 mmol/l, P > 0.05). There was, however a difference in the net-unmeasured-ions (strong-ion-gap). We conclude that acid-base changes with cardiopulmonary bypass may differ with the prime but that the early differences between chloride-only and lactated primes appear not to be due to differences in the measured strong-ion-difference. We suggest future studies examine other possible mechanisms including unmeasured ions.

Metabolic changes and myocardial injury during cardioplegia: a pilot study.

BACKGROUND: The timing, nature, and severity of both increased cardiac troponin I (cTn-I) levels and myocardial injury during ischemic arrest with cardioplegia are unknown. To define them more accurately, we studied myocardial metabolic activity and the release of markers of myocardial cell injury into the coronary sinus before, during, and after cardioplegia. METHODS: We simultaneously measured creatine kinase, creatine kinase-MB, cTn-I, lactate, phosphate, and blood gases in coronary sinus and systemic arterial blood from 12 patients before cardiopulmonary bypass, after removal of the aortic cross-clamp, and after discontinuation of cardiopulmonary bypass. We also measured coronary sinus flow and transmyocardial fluxes of all analytes and calculated myocardial oxygen consumption, myocardial carbon dioxide production, and myocardial energy expenditure. RESULTS: Myocardial lactate release increased 10-fold after removal of the aortic cross-clamp (p = 0.012) and was accompanied by a surge in myocardial phosphate uptake (p = 0.056). These events were associated with only partial cardioplegia-induced suppression of myocardial oxygen consumption (p = 0.0047), myocardial carbon dioxide production (p = 0.0022), and myocardial energy expenditure (p = 0.0029). Simultaneously, coronary sinus cTn-I levels increased from a mean of 0.76 to 2.43 ng/mL after removal of the aortic cross-clamp, and 2.51 ng/mL after cardiopulmonary bypass (p = 0.014), leading to an increase in arterial cTn-I concentration from 0.18 to 0.98 and 3.01 ng/mL (p = 0.0002). Thus, cTn-I release across the myocardium was absent at baseline, became detectable (p = 0.012) after removal of the aortic cross-clamp, and correlated with cross-clamp and pump times. Similar changes occurred with creatine kinase-MB. CONCLUSIONS: Metabolic myocardial stress occurs during ischemic arrest with cardioplegia and is associated with inadequate suppression of metabolism and with a surge in cTn-I and creatine kinase-MB release, which is maximal after removal of the aortic cross-clamp. These changes are likely to represent structural myocardial cell injury.

What controls attention in natural environments?

The highly task-specific fixation patterns revealed in performance of natural tasks demonstrate the fundamentally active nature of vision, and suggest that in many situations, top-down processes may be a major factor in the acquisition of visual information. Understanding how a top-down visual system could function requires understanding the mechanisms that control the initiation of the different task-specific computations at the appropriate time. This is particularly difficult in dynamic environments, like driving, where many aspects of the visual input may be unpredictable. We therefore examined drivers' abilities to detect Stop signs in a virtual environment when the signs were visible for restricted periods of time. Detection performance is heavily modulated both by the instructions and the local visual context. This suggests that visibility of the signs requires active search, and that the frequency of this search is influenced by learnt knowledge of the probabilistic structure of the environment.

In what ways do eye movements contribute to everyday activities?

Two recent studies have investigated the relations of eye and hand movements in extended food preparation tasks, and here the results are compared. The tasks could be divided into a series of actions performed on objects. The eyes usually reached the next object in the sequence before any sign of manipulative action, indicating that eye movements are planned into the motor pattern and lead each action. The eyes usually fixated the same object throughout the action upon it, although they often moved on to the next object in the sequence before completion of the preceding action. The specific roles of individual fixations could be identified as locating (establishing the locations of objects for future use), directing (establishing target direction prior to contact), guiding (supervising the relative movements of two or three objects) and checking (establishing whether some particular condition is met, prior to the termination of an action). It is argued that, at the beginning of each action, the oculomotor system is supplied with the identity of the required object, information about its location, and instructions about the nature of the monitoring required during the action. The eye movements during this kind of task are nearly all to task-relevant objects, and thus their control is seen as primarily 'top-down', and influenced very little by the 'intrinsic salience' of objects.

The coordination of eye, head, and hand movements in a natural task.

Relatively little is known about movements of the eyes, head, and hands in natural tasks. Normal behavior requires spatial and temporal coordination of the movements in more complex circumstances than are typically studied, and usually provides the opportunity for motor planning. Previous studies of natural tasks have indicated that the parameters of eye and head movements are set by global task constraints. In this experiment, we explore the temporal coordination of eye, head, and hand movements while subjects performed a simple block-copying task. The task involved fixations to gather information about the pattern, as well as visually guided hand movements to pick up and place blocks. Subjects used rhythmic patterns of eye, head, and hand movements in a fixed temporal sequence or coordinative structure. However, the pattern varied according to the immediate task context. Coordination was maintained by delaying the hand movements until the eye was available for guiding the movement. This suggests that observers maintain coordination by setting up a temporary, task-specific synergy between the eye and hand. Head movements displayed considerable flexibility and frequently diverged from the gaze change, appearing instead to be linked to the hand trajectories. This indicates that the coordination of eye and head in gaze changes is usually the consequence of a synergistic linkage rather than an obligatory one. These temporary synergies simplify the coordination problem by reducing the number of control variables, and consequently the attentional demands, necessary for the task.

Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis.

BACKGROUND: The development of metabolic acidosis during cardiopulmonary bypass (CPB) is well recognized but poorly understood. The authors hypothesized that the delivery of pump prime fluids is primarily responsible for its development. Accordingly, acid-base changes induced by the establishment of CPB were studied using two types of priming fluid (Haemaccel, a polygeline solution, and Ringer's Injection vs. Plasmalyte 148) using quantitative biophysical methods. METHODS: A prospective, double-blind, randomized trial was conducted at a tertiary institution with 22 patients undergoing CPB for coronary artery bypass surgery. Sampling of arterial blood was performed at three time intervals: before CPB (t1), 2 min after initiation of CPB at full flows (t2), and at the end of the case (t3). Measurements of Na+, K+, Mg2+, Cl-, HCO3-, phosphate, Ca2+, albumin, lactate, and arterial blood gases at each collection point were performed. Results were analyzed in a quantitative manner. RESULTS: Immediately on delivery of pump prime fluids, all patients developed a metabolic acidosis (base excess: 0. 95 mEq/l (t1) to -3.65 mEq/l (t2) (P < 0.001) for Haemaccel-Ringer's and 1.17 mEq/l (t1) to -3.20 mEq/l (t2). The decrease in base excess was the same for both primes (-4.60 vs. -4.37; not significant). However, the mechanism of metabolic acidosis was different. With the Haemaccel-Ringer's prime, the metabolic acidosis was hyperchloremic (Delta Cl-, +9.50 mEq/l; confidence interval, 7.00-11.50). With Plasmalyte 148, the acidosis was induced by an increase in unmeasured anions, most probably acetate and gluconate. The resolution of these two processes was different because the excretion of chloride was slower than that of the unmeasured anions (Delta base excess from t1 to t3 = -1.60 for Haemaccel-Ringer's vs. +1.15 for Plasmalyte 148; P = 0.0062). CONCLUSIONS: Cardiopulmonary bypass-induced metabolic acidosis appears to be iatrogenic in nature and derived from the effect of pump prime fluid on acid-base balance. The extent of such acidosis and its duration varies according to the type of pump prime.

Spatio-temporal organization of behavior.

One of the most widely used terms in the study of human performance is attention. Yet it can also be argued that it is one of the most confusing and misunderstood. Huge variations in performance, from not noticing large changes in images or natural situations, to differences of tens of milliseconds have all been described as attentional effects. We argue that the large disparity in results can be more easily understood in the context of a fairly complete model of human performance that describes the execution of a set of complex natural tasks via a collection of visual routines that extract crucial information from the optical array. The description of visual routines is hierarchical. At the most abstract level, a scheduler must pick a small set of programs for the current tasks. Each program contains steps which are keyed to information in the scene. This is extracted by visual routines which run during a single fixation and extract pertinent information. The library of routines themselves are designed to execute quickly, but their actual performance depends on signal-to-noise characteristics of the imaged scene. The hierarchical description of behavior shows that questions about attention make sense in the context of the descriptive level in which they are embedded. We illustrate these principles with examples of driving behaviors.

The aetiology and pathogenesis of cardiopulmonary bypass-associated metabolic acidosis using polygeline pump prime.

OBJECTIVE: The pathogenesis of the metabolic acidosis of cardiopulmonary bypass (CPB) is not fully understood. New quantitative methods of acid-base balance now make it possible to describe it more clearly. Accordingly, we studied acid-base changes during CPB with polygeline pump prime and defined and quantified the factors which contribute to metabolic acidosis. DESIGN: Prospective cohort study. SETTING: Tertiary institution. PARTICIPANTS: 10 cardiac bypass graft surgery patients. INTERVENTIONS: Sampling of arterial blood at four time intervals: post-induction, on CPB during cooling and rewarming, and at skin closure. Measurement of serum Na+, K+, Mg++, Ca++, Cl-, bicarbonate, and phosphate concentrations, arterial blood gases, and serum albumin, lactate, and pyruvate concentrations at each collection point. Analysis of findings according to quantitative physicochemical principles, including calculation of the strong ion difference apparent, the strong ion difference effective, and the strong ion gap (SIG). MEASUREMENTS AND MAIN RESULTS: All patients developed a mild metabolic acidosis. The median serum standard bicarbonate concentration decreased from 25.0 mEq/l post-induction to 22.3 mEq/l at cooling and 22.2 mEq/l at rewarming (p < 0.05). The standard base excess decreased from a median of 1.55 mEq/l prior to CPB, to -2.50 mEq/l at cooling, -1.65 mEq/l at rewarming and, -0.85 mEq/l at skin closure (p < 0.001). This mild metabolic acidosis occurred despite a decrease in the median serum lactate concentration from 3.20 mEq/l post-induction to 1.83, 1.80, and 1.58 mEq/l at the three other time points. The increase in the median serum chloride concentration from 104.9 mEq/l post induction to 111.0, 111.1, and 110.0 mEq/l at the subsequent time points (p < 0.0001) was the main cause of the acidosis. There was also a significant increase in the SIG of 3.8 mEq/l at cooling and rewarming (p < 0.0001), suggesting a role for other unmeasured anions (polygeline) in the genesis of this acidosis. CONCLUSIONS: Using quantitative biophysical methods, it can be demonstrated that, in patients receiving a pump prime rich in chloride and polygeline, the metabolic acidosis of CPB is mostly due to iatrogenic increases in serum chloride concentration and unmeasured strong anions (SIG). Its development is partially attenuated by iatrogenic hypoalbuminaemia. Changes in lactate concentrations did not play a role in the development of metabolic acidosis in our patients.

Role of the splanchnic circulation in acid-base balance during cardiopulmonary bypass.

OBJECTIVE: The role of the splanchnic circulation in the development of the metabolic acidosis of cardiopulmonary bypass (CPB) is not fully understood. New quantitative methods of acid-base balance now offer the ability to define this phenomenon more accurately. Accordingly, we studied acid-base changes across the splanchnic circulation during CPB and defined and quantified the factors that contributed to acid-base balance. DESIGN: Prospective cohort study. SETTING: Tertiary institution. PATIENTS: Ten patients undergoing CPB for coronary artery bypass surgery. INTERVENTIONS: Sampling of arterial and hepatic venous blood at four time intervals: postinduction, on CPB during cooling and rewarming, and at skin closure. MEASUREMENTS: Measurement of serum Na+, K+, Mg++, Ca++, Cl-, HCO3-, and phosphate concentrations, arterial and hepatic venous blood gases and serum albumin, and lactate and pyruvate concentrations at each collection point. Analysis of findings according to quantitative physicochemical principles. MAIN RESULTS: All patients developed a mild metabolic acidosis with a decrease in median serum bicarbonate concentration from 24.97 mEq/L after induction to 22.29 mEq/L at cooling and 22.23 mEq/L at rewarming (p < .05). Before CPB, the pH decreased by 0.0275 (p < .05) across the splanchnic circulation, representing an increase of 2.26 nmol/L of hydrogen ions. Nevertheless, the splanchnic circulation induced a metabolic alkalosis, with a median transsplanchnic increase in the base excess of 1.50 mEq/L (p < .05). This change was largely due to a decrease in serum chloride and lactate concentration across the splanchnic circulation (p < .05). The acidifying effect of the splanchnic circulation was therefore the result of cell respiration with a median increase in carbon dioxide tension of 5.75 mm Hg (p < .05), causing the strong ion difference effective to increase by 1.94 mEq/L (p < .05). There were no other anions or acids added to the circulation by splanchnic organs (no change in strong ion gap). During and after CPB the splanchnic metabolic alkalinizing effect continued and the respiratory acidifying effect was reduced. This caused the splanchnic circulation to be pH neutral at these times. CONCLUSIONS: Using quantitative biophysical methods it can be demonstrated that the splanchnic circulation does not contribute to the metabolic acidosis of CPB, and that it continues to have a metabolic alkalinizing effect involving significant lactate extraction. However, its respiratory acidifying effect continues, although at a reduced rate.

Task constraints in visual working memory.

This paper examines the nature of visual representations that direct ongoing performance in sensorimotor tasks. Performance of such natural tasks requires relating visual information from different gaze positions. To explore this we used the technique of making task relevant display changes during saccadic eye movements. Subjects copied a pattern of colored blocks on a computer monitor, using the mouse to drag the blocks across the screen. Eye position was monitored using a dual-purkinje eye tracker, and the color of blocks in the pattern was changed at different points in task performance. When the target of the saccade changed color during the saccade, the duration of fixations on the model pattern increased, depending on the point in the task that the change was made. Thus different fixations on the same visual stimulus served a different purpose. The results also indicated that the visual information that is retained across successive fixations depends on moment by moment task demands. This is consistent with previous suggestions that visual representations are limited and task dependent. Changes in blocks in addition to the saccade target led to greater increases in fixation duration. This indicated that some global aspect of the pattern was retained across different fixations. Fixation durations revealed effects of the display changes that were not revealed in perceptual report. This can be understood by distinguishing between processes that operate at different levels of description and different time scales. Our conscious experience of the world may reflect events over a longer time scale than those underlying the substructure of the perceptuo-motor machinery.

Reference frames in saccadic targeting.

We attempt to determine the egocentric reference frame used in directing saccades to remembered targets when landmark-based (exocentric) cues are not available. Specifically, we tested whether memory-guided saccades rely on a retina-centered frame, which must account for eye movements that intervene during the memory period (thereby accumulating error) or on a head-centered representation that requires knowledge of the position of the eyes in the head. We also examined the role of an exocentric reference frame in saccadic targeting since it would not need to account for intervening movements. We measured the precision of eye movements made by human observers to target locations held in memory for a few seconds. A variable number of saccades intervened between the visual presentation of a target and a later eye movement to its remembered location. A visual landmark that allowed for exocentric encoding of the memory target appeared in half the trials. Variable error increased slightly with a greater number of intervening saccades. The landmark aided targeting precision, but did not eliminate the increase in variable error with additional intervening saccades. We interpret these results as evidence for a representation that relies on knowledge of eye position with respect to the head and not one that relies solely on updating in a retina-centered frame. Our results allow us to set an upper bound on the standard deviation of an eye position signal available to the saccadic system during short memory periods at 1.4 degrees for saccades of about 10 degrees.

Deictic codes for the embodiment of cognition.

To describe phenomena that occur at different time scales, computational models of the brain must incorporate different levels of abstraction. At time scales of approximately 1/3 of a second, orienting movements of the body play a crucial role in cognition and form a useful computational level--more abstract than that used to capture natural phenomena but less abstract than what is traditionally used to study high-level cognitive processes such as reasoning. At this "embodiment level," the constraints of the physical system determine the nature of cognitive operations. The key synergy is that at time scales of about 1/3 of a second, the natural sequentiality of body movements can be matched to the natural computational economies of sequential decision systems through a system of implicit reference called deictic in which pointing movements are used to bind objects in the world to cognitive programs. This target article focuses on how deictic binding make it possible to perform natural tasks. Deictic computation provides a mechanism for representing the essential features that link external sensory data with internal cognitive programs and motor actions. One of the central features of cognition, working memory, can be related to moment-by-moment dispositions of body features such as eye movements and hand movements.

Goal-directed arm movements change eye-head coordination.

We compared the head movements accompanying gaze shifts while our subjects executed different manual operations, requiring gaze shifts of about 30 degrees. The different tasks yielded different latencies between gaze shifts and hand movements, and different maximum velocities of the hand. These changes in eye-hand coordination had a clear effect on eye-head coordination: the latencies and maximum velocities of head and hand were correlated. The same correlation between movements of the head and hand was also found within a task. Therefore, the changes in eye-head coordination are not caused by changes in the strategy of the subjects. We conclude that head movements and saccades during gaze shifts are not based on the same command: head movements depend both on the actual saccade and on possible future gaze shifts.

The role of exocentric reference frames in the perception of visual direction.

One classic piece of evidence for an efference copy signal of eye position is that a small, positive afterimage viewed in darkness is perceived to move with the eye. When a small stationary reference point is visible the afterimage appears to move relative to the reference point. However, this is true only when the afterimage is localized to a small area. We have observed that when an extended afterimage of a complex scene is generated by a brief, bright flash it does not appear to move, even with large changes in eye position. When subjects were instructed to maintain their direction of gaze, we observed small saccades (typically < 1 deg) and slow drift movements often totalling more than 10 deg over a 30 sec period. When the instructions were to simply inspect the extended afterimage, subjects made larger saccades (up to 5 deg) which were not accompanied by afterimage movement. The smaller movements observed under the first instructions are greater than those observed in the dark or with small afterimages. When a visible reference is present with these large afterimages, the afterimage appears stationary, while the reference point appears to move. Eye position was monitored following the generation of such afterimages. In general, the perceived motion of the stationary reference point was in a direction opposite to the motion of the eye. Similar drift movements of smaller magnitude were observed with localized afterimages, but the motion was attributed to the afterimage.(ABSTRACT TRUNCATED AT 250 WORDS)

Capacity limitations in memory for visual locations.

This paper examines people's ability to make judgments which require them to know the relative positions of objects that are not simultaneously visible is examined. It has previously been shown that people can accurately perform such a task. The current experiments test the capacity limits for such tasks. Two experiments were conducted that required subjects to make spatial judgments based on sequences of points presented two at a time. It was shown that, whereas subjects can perform accurately when memory for a small number of dots (about four) is required, increasing the number of dots results in a radical reduction in performance. This argues against both the idea that spatial memory is based on a linguistic description and the idea that it is based on an image-like representation. Rather it appears that one can form an accurate representation of the spatial properties of a small number of objects.

Memory representations in natural tasks.

Abstract The very limited capacity of short-term or working memory is one of the most prominent features of human cognition. Most studies have stressed delimiting the upper bounds of this memory in memorization tasks rather than the performance of everyday tasks. We designed a series of experiments to test the use of short-term memory in the course of a natural hand-eye task where subjects have the freedom to choose their own task parameters. In this case subjects choose not to operate at the maximum capacity of short-term memory but instead seek to minimize its use. In particular, reducing the instantaneous memory required to perform the task can be done by serializing the task with eye movements. These eye movements allow subjects to postpone the gathering of task-relevant information until just before it is required. The reluctance to use short-term memory can be explained if such memory is expensive to use with respect to the cost of the serializing strategy.

Surface segmentation mechanisms and motion perception.

Two studies are presented which explore how depth information is determined from conditions of transparency and whether this information combines with other depth information to determine the segmenting of motion information on the basis of likely surface boundaries. The first study explored how binocular disparity combines with monocular depth cues associated with transparency to determine whether subjects see one or multiple surfaces in depth in static displays. When transparency provided a depth cue that was consistent with binocular disparity, depth discrimination thresholds were at normal levels. However, if transparency was inconsistent with the binocular disparity, depth discrimination thresholds were elevated, indicating that subjects had difficulty seeing distinct surfaces lying in separate depth planes. Moreover, threshold elevations were found to correspond to the reductions in contrast between the intersecting contours of the stimulus, suggesting that the strength of perceived depth from transparency is the result of attenuated responses from competing contrast sensitive T-junction mechanisms responsible for the detection of opaque occlusion. A second experiment explored whether the grouping of local motion signals relied on surface interpretations that result from the interaction of transparency and disparity. Surface interpretations were manipulated in moving plaids by combining transparent layering and binocular disparity to show that the motion arising from contours is grouped together (pattern motion) when these cues support the existence of a single surface, and is segregated (component motion) when they support separate surfaces. When these cues were consistent, only small disparity differences were required for the gratings to appear as separately moving surfaces. However, when they were inconsistent, greater disparities were required (about a factor of 2 greater). Taken together, these studies demonstrate that the grouping of local motion information is not resolved within the motion system alone. Information seemingly unrelated to motion processing, namely surface segmentation cues, is used to determine whether or not motion information arising from various contours is pooled together to determine a single motion.

Hand-eye coordination during sequential tasks.

The small angle subtended by the human fovea places a premium on the ability to quickly and accurately direct the gaze to targets of interest. Thus the resultant saccadic eye fixations are a very instructive behaviour, revealing much about the underlying cognitive mechanisms that guide them. Of particular interest are the eye fixations used in hand-eye coordination. Such coordination has been extensively studied for single movements from a source location to a target location. In contrast, we have studied multiple fixations where the sources and targets are a function of a task and chosen dynamically by the subject according to task requirements. The task chosen is a copying task: subjects must copy a figure made up of contiguous coloured blocks as fast as possible. The main observation is that although eye fixations are used for the terminal phase of hand movements, they are used for other tasks before and after that phase. The analysis of the spatial and temporal details of these fixations suggests that the underlying decision process that moves the eyes leaves key decisions until just before they are required.

Subtractive processes in light adaptation.

We measured the time course of light adaptation in foveal vision following the onset of an adapting background. Several adaptational steps in the low to mid photopic range were examined. The time course of multiplicative and subtractive components of the adaptation were extracted from the data. Unlike previous findings there were no subtractive changes for several hundred milliseconds following light onset, and the process took 10-15 sec to reach steady state. It seems likely that the fast component previously observed results from effectively instantaneous center-surround antagonism, and that our measurements reflect a second subtractive process involving the slow loss of the d.c. signal over time.

Integration of form across saccadic eye movements.

To perceive a stable world, one must somehow be able to relate visual information from successive fixations. Little is known, however, about the nature of the integrative process. By using a task which requires the integration of spatial position information from different fixations, it is demonstrated that visual information from previous fixations is preserved in a world-centered representation which is precise enough to support judgements of geometric shape. It is also shown that successive views are aligned with respect to common visual features, indicating that visual stability may be normally accomplished by a visual matching strategy in combination with cancellation by an eye-position signal.