Long-term outcome of acute type A aortic dissection repair in chronic kidney disease patients.

Preoperative renal dysfunction is associated with mortality in patients with acute type A aortic dissection (ATAAD) repair. However, the long-term outcome of chronic kidney dysfunction (CKD) in ATAAD is unclear. The study aimed to evaluate the long-term outcome of CKD in patients with ATAAD repair. We retrospectively studied patients with ATAAD repair using data from the Taiwan's National Health Insurance Research Database between July 1, 2004, and December 31, 2013. The outcomes of interest included all-cause mortality, readmission due to any cause, redo aortic surgery, major adverse cardiac and cerebrovascular events, and liver and renal outcomes. There were 3328 patients who received ATAAD repair. These patients were divided into CKD and non-CKD groups. In-hospital mortality in the CKD group was significantly higher than that in the non-CKD group (32.5% vs 18.8%, respectively, odds ratio 2.14, 95% confidence interval [CI] 1.37-3.36). During long-term follow-up, patients with CKD had higher risks of all-cause mortality including in-hospital death (52.6% vs 32.5%; hazard ratio 1.83, 95% CI 1.32-2.55), mortality after discharge (29.7% vs 16.8%; hazard ratio 2.09, 95% CI 1.02-4.29), and readmission rates (67.1% vs 51.6%; subdistribution hazard ratio 2.00, 95% CI 1.43-2.79). However, no significant difference was observed between the dialysis and non-dialysis groups. On the basis of our results, patients with CKD carry a poor long-term outcome after ATAAD repair. Cardiac surgeons should be aware of this condition when dealing with ATAAD repair.

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial.

BACKGROUND: Target-controlled infusion (TCI) of propofol is a well-established method of procedural sedation and has been used in Japan for anesthesia during electroconvulsive therapy (ECT). However, the usefulness of the TCI of propofol for ECT has yet to be determined. This study aimed to compare the TCI and manual infusion (MI) of propofol anesthesia during ECT. METHODS: A total of forty psychiatric inpatients receiving bitemporal ECT were enrolled in the present study and randomized into the TCI group (N = 20) and the MI group (N = 20). Clinical Global Impression (CGI) and Montreal Cognitive Assessment (MoCA) scores were measured before and after ECT. The clinical outcomes, anesthesia-related variables, and ECT-related variables were compared between the two groups. Generalized estimating equations (GEEs) were used to model the comparison throughout the course of ECT. RESULTS: A total of 36 subjects completed the present study, with 18 subjects in each group. Both the groups didn't significantly differ in the post-ECT changes in CGI and MoCA scores. However, concerning MoCA scores after 6 treatments of ECT, the MI group had improvement while the TCI group had deterioration. Compared with the MI group, the TCI group had higher doses of propofol, and longer procedural and recovery time. The TCI group seemed to have more robust seizures in the early course of ECT but less robust seizures in the later course of ECT compared with the MI group. CONCLUSIONS: The present study does not support the use of TCI of propofol for anesthesia of ECT. TRIAL REGISTRATION: (ClinicalTrials.gov): NCT03863925 . Registered March 5, 2019 - Retrospectively registered.

Kinetics of cell lysis for Microcystis aeruginosa and Nitzschia palea in the exposure to ß-cyclocitral.

The effect of an algal metabolite, ß-cyclocitral, on the cell integrity of two cyanobacteria and one diatom was investigated. The cyanobacteria, Microcystis aeruginosa PCC 7005 and PCC 7820, and the diatom, Nitzschia palea, were exposed to various concentrations of ß-cyclocitral. Scanning electron microscope (SEM) results indicate that the cells of tested species were greatly altered after being exposed to ß-cyclocitral. A flow cytometer coupled with the SYTOX stain and chlorophyll-a auto-fluorescence was used to quantify the effect of ß-cyclocitral on cell integrity for the tested cyanobacteria and diatom. Kinetic experiments show that about 5-10 mg L(-1) of ß-cyclocitral for the two M. aeruginosa strains and a much lower concentration, 0.1-0.5 mg L(-1), for N. palea were needed to cause 15-20% of cells to rupture. When the ß-cyclocitral concentration was increased to 200-1000 mg L(-1) for M. aeruginosa and 5-10 mg L(-1) for N. palea, almost all the cells ruptured between 8 and 24h. A first-order kinetic model is able to describe the data of cell integrity over time. The extracted rate constant values well correlate with the applied ß-cyclocitral dosages. The obtained kinetic parameters may be used to estimate ß-cyclocitral dosage and contact time required for the control of cyanobacteria and diatoms in water bodies.