Red Blood Cell Transfusion Requirements Before and After Implementation of a Perioperative Patient Blood Management Program in Adult Patients Undergoing Cardiac Surgery. A Before and After Observational Study.

OBJECTIVES: Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program. DESIGN: Before-and-after observational study. SETTING: Single-center French university teaching hospital. PARTICIPANTS: Adult patients scheduled for cardiac surgery. INTERVENTIONS: Perioperative patient blood management program including pre-, intra-, and postoperative interventions aimed at identifying and correcting anemia, minimizing blood loss during surgery, and optimizing coagulation. MEASUREMENTS AND MAIN RESULTS: Four hundred thirty-four patients were included in the study from January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first 2 postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (p < 0.001). The application of a PBM program was associated with a reduction in perioperative RBC transfusion by multivariate analysis (odds ratio 0.55, 95% CI 0.36-0.85, p = 0.007), and was associated with a reduction in the median number of RBC units transfused within transfused patients (p = 0.025). These effects persisted at day 30 after surgery (p = 0.029). CONCLUSION: A perioperative PBM program in adult patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, which persisted at day 30.

Enhancement of Hydrophilicity of Nano-Pitted TiO2 Surface Using Phosphoric Acid Etching.

Our research group developed a novel nano-pitted (NP) TiO2 surface on grade 2 titanium that showed good mechanical, osteogenic, and antibacterial properties; however, it showed weak hydrophilicity. Our objective was to develop a surface treatment method to enhance the hydrophilicity of the NP TiO2 surface without the destruction of the nano-topography. The effects of dilute and concentrated orthophosphoric (H3PO4) and nitric acids were investigated on wettability using contact angle measurement. Optical profilometry and atomic force microscopy were used for surface roughness measurement. The chemical composition of the TiO2 surface and the oxidation state of Ti was investigated using X-ray photoelectron spectroscopy. The ccH3PO4 treatment significantly increased the wettability of the NP TiO2 surfaces (30°) compared to the untreated control (88°). The quantity of the absorbed phosphorus significantly increased following ccH3PO4 treatment compared to the control and caused the oxidation state of titanium to decrease (Ti4+ → Ti3+). Owing to its simplicity and robustness the presented surface treatment method may be utilized in the industrial-scale manufacturing of titanium implants.

Iodide Removal by Resorcinol-Formaldehyde Carbon Aerogels.

The adsorption technique is widely used in water purification, and its efficiency can be significantly improved by target-specific adsorbent design. Research on iodine and its ion removal from water has attracted a great deal of interest due to increased concentrations in the environment and acute toxic effects, e.g., in human thyroid cells. In this work, the iodide removal performance of two high-surface-area resorcinol-formaldehyde-based carbon aerogels was studied under acidic conditions. The BET surface area was 790 m2/g (RF_ac) and 375 m2/g (RMF-GO), with a corresponding micropore ratio of 36 and 26%, respectively. Both aerogels showed outstanding adsorption capacity, exceeding the reported performance of other carbons and Ag-doped materials. Owing to its basic nature, the RMF-GO carbon aerogel showed higher I- capacity, up to 97 mg/g, than the acidic RF_ac, which reached a capacity of 82 mg/g. The surface chemistry of the aerogels also played a distinct role in the removal. In terms of kinetics, RF_ac removed 60% of the iodide ions and RMF-GO 30% within 8 h. The removal kinetics was of the first order, with a half-life of 1.94 and 1.70 h, respectively.

The applicability of the Beck Depression Inventory and Hamilton Depression Scale in the automatic recognition of depression based on speech signal processing.

Depression is a growing problem worldwide, impacting on an increasing number of patients, and also affecting health systems and the global economy. The most common diagnostical rating scales of depression are self-reported or clinician-administered, which differ in the symptoms that they are sampling. Speech is a promising biomarker in the diagnostical assessment of depression, due to non-invasiveness and cost and time efficiency. In our study, we try to achieve a more accurate, sensitive model for determining depression based on speech processing. Regression and classification models were also developed using a machine learning method. During the research, we had access to a large speech database that includes speech samples from depressed and healthy subjects. The database contains the Beck Depression Inventory (BDI) score of each subject and the Hamilton Rating Scale for Depression (HAMD) score of 20% of the subjects. This fact provided an opportunity to compare the usefulness of BDI and HAMD for training models of automatic recognition of depression based on speech signal processing. We found that the estimated values of the acoustic model trained on BDI scores are closer to HAMD assessment than to the BDI scores, and the partial application of HAMD scores instead of BDI scores in training improves the accuracy of automatic recognition of depression.

Biomass Related Highly Porous Metal Free Carbon for Gas Storage and Electrocatalytic Applications.

In this paper we report the synthesis of a N, S co-doped metal free carbon cryogel obtained from a marine biomass derived precursor using urea as nitrogen source. Natural carrageenan intrinsically contains S and inorganic salt. The latter also serves as an activating agent during the pyrolytic step. The overall 11.6 atomic % surface heteroatom concentration comprises 5% O, 4.6% N and 1% S. The purified and annealed final carbon (CA) has a hierarchical pore structure of micro-, meso- and macropores with an apparent surface area of 1070 m2/g. No further treatment was applied. The gas adsorption potential of the samples was probed with H2, CO2 and CH4, while the electrocatalytic properties were tested in an oxygen reduction reaction. The atmospheric CO2 and CH4 storage capacity at 0 °C in the low pressure range is very similar to that of HKUST-1, with the CO2/CH4 selectivity below 20 bar, even exceeding that of the MOF, indicating the potential of CA in biogas separation. The electrocatalytic behavior was assessed in an aqueous KOH medium. The observed specific gravimetric capacitance 377 F/g was exceeded only in B, N dual doped and/or graphene doped carbons from among metal free electrode materials. The CA electrode displays almost the same performance as a commercial 20 wt% Pt/C electrode. The oxygen reduction reaction (ORR) exhibits the 4-electron mechanism. The 500-cycle preliminary stability test showed only a slight increase of the surface charge.

Genetic Algorithm Driven Force Field Parameterization for Molten Alkali-Metal Carbonate and Hydroxide Salts.

Molten alkali-metal carbonates and hydroxides play important roles in the molten carbonate fuel cell and in Earth's geochemistry. Molecular simulations allow us to study these systems at extreme conditions without the need for difficult experimentation. Using a genetic algorithm to fit ab intio molecular dynamics-computed densities and radial distribution functions, as well as experimental enthalpies of formation, we derive new classical force fields able to accurately predict liquid chemical potentials. These fitting properties were chosen to ensure accurate liquid phase structure and energetics. Although the predicted dynamics is slow when compared to experiments, in general the trends in dynamic properties across different systems still hold true. In addition, these newly parametrized force fields can be extended to the molten carbonate-hydroxide mixtures by using standard combining rules.

Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia.

Nonintubated thoracic surgery (NITS) has a good safety record in experienced hands, but has pitfalls for beginners. The main aim of NITS is to keep the patient under spontaneous respiration, avoiding adverse effects, such as hypoxemia, hypercapnia, panic attacks, and finally conversion to general anesthesia. In this paper, the safety aspects of anesthesia for NITS is discussed based on data from the literature and personnel clinical experiences.

In situ impedance matching in Nb/Nb2O5/PtIr memristive nanojunctions for ultra-fast neuromorphic operation.

The dynamical aspects of bipolar resistive switchings have been investigated in Nb/Nb2O5/PtIr nanojunctions. We found that the widely tuneable ON and OFF state resistances are well separated at low bias. On the other hand, the high-bias regime of the resistive switchings coincides with the onset of a high nonlinearity in the current-voltage characteristics, where the impedance of both states rapidly decreases and becomes equivalent around 50 Ω. This phenomenon enables the overriding of the RC limitations of fast switchings between higher resistance ON and OFF states. Consequently, nanosecond switching times between multiple resistance states due to subnanosecond voltage pulses are demonstrated. Moreover, this finding provides the possibility of impedance engineering by the appropriate choice of voltage signals, which facilitates that both the set and reset transitions take place in an impedance matched manner to the surrounding circuit, demonstrating the merits of ultra-fast operation of Nb2O5 based neuromorphic networks.

Emergency Valve Replacement Under Minimal Cardiopulmonary Bypass for a Patient With Infective Endocarditis and Large Brain Hematoma: A Case Report.

A 19-year-old man with mitral valve endocarditis and prolapse, intracerebral and intracerebellar hematoma, and a mycotic cerebral aneurysm underwent emergency mitral valve replacement during minimal cardiopulmonary bypass (total priming volume, 800 mL; autologous retropriming, activated clotting time <300 seconds) 1 day after undergoing endovascular coil embolization of the aneurysm. Postoperatively, there were no extensions of the intracerebral and intracerebellar hematoma. After intensive rehabilitation therapy, the patient recovered fully except for residual bilateral claudication because of preoperative bilateral embolism to both superficial femoral arteries.

Controlling Mackey-Glass chaos.

The Mackey-Glass equation is the representative example of delay induced chaotic behavior. Here, we propose various control mechanisms so that otherwise erratic solutions are forced to converge to the positive equilibrium or to a periodic orbit oscillating around that equilibrium. We take advantage of some recent results of the delay differential literature, when a sufficiently large domain of the phase space has been shown to be attractive and invariant, where the system is governed by monotone delayed feedback and chaos is not possible due to some Poincaré-Bendixson type results. We systematically investigate what control mechanisms are suitable to drive the system into such a situation and prove that constant perturbation, proportional feedback control, Pyragas control, and state dependent delay control can all be efficient to control Mackey-Glass chaos with properly chosen control parameters.

Long-term clinical and experimental/surface analytical studies of carbon/carbon maxillofacial implants.

BACKGROUND: Over the past 30-40 years, various carbon implant materials have become more interesting, because they are well accepted by the biological environment. The traditional carbon-based polymers give rise to many complications. The polymer complication may be eliminated through carbon fibres bound by pyrocarbon (carbon/carbon). The aim of this study is to present the long-term clinical results of carbon/carbon implants, and the results of the scanning electron microscope and energy dispersive spectrometer investigation of an implant retrieved from the human body after 8 years. METHODS: Mandibular reconstruction (8-10 years ago) was performed with pure (99.99 %) carbon implants in 16 patients (10 malignant tumours, 4 large cystic lesions and 2 augmentative processes). The long-term effect of the human body on the carbon/carbon implant was investigated by comparing the structure, the surface morphology and the composition of an implant retrieved after 8 years to a sterilized, but not implanted one. RESULTS: Of the 16 patients, the implants had to be removed earlier in 5 patients because of the defect that arose on the oral mucosa above the carbon plates. During the long-term follow-up, plate fracture, loosening of the screws, infection or inflammations around the carbon/carbon implants were not observed. The thickness of the carbon fibres constituting the implants did not change during the 8-year period, the surface of the implant retrieved was covered with a thin surface layer not present on the unimplanted implant. The composition of this layer is identical to the composition of the underlying carbon fibres. Residual soft tissue penetrating the bulk material between the carbon fibre bunches was found on the retrieved implant indicating the importance of the surface morphology in tissue growth and adhering implants. CONCLUSIONS: The surface morphology and the structure were not changed after 8 years. The two main components of the implant retrieved from the human body are still carbon and oxygen, but the amount of oxygen is 3-4 times higher than on the surface of the reference implant, which can be attributed to the oxidative effect of the human body, consequently in the integration and biocompatibility of the implant. The clinical conclusion is that if the soft part cover is appropriate, the carbon implants are cosmetically and functionally more suitable than titanium plates.

[DRUG THERAPY OF NEUROPATHIC PAIN BASED ON THE LATEST RECOMMENDATIONS]. / A NEUROPATHIÁS FÁJDALOM GYÓGYSZERES KEZELÉSE A LEGUTÓBBI AJÁNLÁSOK TÜKRÉBEN.

Neuropathic pain is considered as a special type of different pain conditions. It's pathophysiological basis and treatment is completely different from the nociceptive pain. The first comprehensive therapeutic guidelines published approximately a decade ago recommended tricyclic antidepressants, anticonvulsants and opioids. The recent summary presents and evaluates national and international guidelines issued in the last five years. The most frequently suggested drugs by all guidelines are amitriptyline, duloxetine, gabapentin and pregabalin. Pregabalin is the only drug that is recommended first line in all guidelines referred. Opioids are in the second or third line. There seems to be no major development in the pharmacological treatment of the neuropathic pain compared to the earlier recommendations. High quality studies of head to head comparisons and effectiveness of combination therapy are still lacking.

Multiprocessor Neural Network in Healthcare.

A possible way of creating a multiprocessor artificial neural network is by the use of microcontrollers. The RISC processors' high performance and the large number of I/O ports mean they are greatly suitable for creating such a system. During our research, we wanted to see if it is possible to efficiently create interaction between the artifical neural network and the natural nervous system. To achieve as much analogy to the living nervous system as possible, we created a frequency-modulated analog connection between the units. Our system is connected to the living nervous system through 128 microelectrodes. Two-way communication is provided through A/D transformation, which is even capable of testing psychopharmacons. The microcontroller-based analog artificial neural network can play a great role in medical singal processing, such as ECG, EEG etc.

Transmission Dynamics and Final Epidemic Size of Ebola Virus Disease Outbreaks with Varying Interventions.

The 2014 Ebola Virus Disease (EVD) outbreak in West Africa was the largest and longest ever reported since the first identification of this disease. We propose a compartmental model for EVD dynamics, including virus transmission in the community, at hospitals, and at funerals. Using time-dependent parameters, we incorporate the increasing intensity of intervention efforts. Fitting the system to the early phase of the 2014 West Africa Ebola outbreak, we estimate the basic reproduction number as 1.44. We derive a final size relation which allows us to forecast the total number of cases during the outbreak when effective interventions are in place. Our model predictions show that, as long as cases are reported in any country, intervention strategies cannot be dismissed. Since the main driver in the current slowdown of the epidemic is not the depletion of susceptibles, future waves of infection might be possible, if control measures or population behavior are relaxed.

Non-intubated anesthesia in thoracic surgery-technical issues.

Performing awake thoracic surgery (ATS) is technically more challenging than thoracic surgery under general anesthesia (GA), but it can result in a greater benefit for the patient. Local wound infiltration and lidocaine administration in the pleural space can be considered for ATS. More invasive techniques are local wound infiltration with wound catheter insertion, thoracic wall blocks, selective intercostal nerve blockade, thoracic paravertebral blockade and thoracic epidural analgesia, offering the advantage of a catheter placement which can also be continued for postoperative analgesia.

Nonintubated anesthesia in thoracic surgery: general issues.

Anesthetic management for awake thoracic surgery (ATS) is more difficult than under general anesthesia (GA), being technically extremely challenging for the anesthesiologist. Therefore, thorough preparation and vigilance are paramount for successful patient management. In this review, important considerations of nonintubated anesthesia for thoracic surgery are discussed in view of careful patient selection, anesthetic preparation, potential perioperative difficulties and the management of its complications.

Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia.

OBJECTIVES: General anaesthesia (GA) carries high risks of ventilator dependency with increased morbidity and mortality in patients with severe respiratory disease. It also presents an ethical dilemma if surgery remains the only treatment option for patients with advanced terminal chronic respiratory disease. Thoracic epidural anaesthesia for awake thoracic surgery (TEATS) in high-risk patients with dyspnoea at rest could avoid ventilator dependency and speed up recovery even in patients with severe dyspnoea. This retrospective observational study analysed indications, management and outcome of patients contraindicated to GA undergoing awake thoracic surgery with thoracic epidural anaesthesia. METHODS: From 716 patients requiring thoracic surgery, nine were contraindicated to GA. Eight patients [American Society of Anesthesiologists (ASA) 4] had a maximum grade four of the modified Medical Research Council dyspnea scale (MMRC). Two patients (ASA 3, grade 1 MMRC and ASA 4, grade 4 MMRC) refused GA. RESULTS: Patients (female : male ratio 1.25 : 1, age 19-76 years) had the following chronic respiratory diseases: pulmonary fibrosis (n = 2), pulmonary metastases (n = 3), chronic obstructive pulmonary disease (n = 1), alveolitis (n = 1) and myopathy (n = 2). Surgical indications were: thoracotomy (n = 6) for pleurectomy to treat recurring pneumothorax (n = 3), pleurostomy (n = 1), emphysema surgery (n = 1), lung biopsy (n = 1) and thoracoscopy (n = 3) for pleural/lung biopsy (n = 2), pneumothorax (n = 1). Lidocaine 20 mg/ml or ropivacaine 7.5 mg/ml was titrated to achieve an anaesthesia level T2-T12. No patient required GA [time of surgery: 46-128 min, mean = 76 min, standard deviation (SD) = 23 min]. Seven patients had light sedation with TCI propofol, remifentanyl or both and remained responsive. Fifty percent of patients received phenylephrine or ephedrine to maintain arterial pressure. Two patients went into hypercapnia, which was reversed with assisted mask ventilation. One patient suffered acute respiratory distress 7 days postoperatively and died of intestinal bleeding on Day 25. There were no postoperative complications in other patients. Excluding Patient 9 always remaining in a medical intensive care unit (ICU), the mean postoperative ICU stay in thoracic surgery was 4.4 days (SD 5.2). Hospital discharge was between 5 and 40 days after surgery. CONCLUSIONS: TEATS with/without sedation was an alternative to GA for thoracotomy/thoracoscopy in severely dyspnoeic patients (MMRC grade 4, ASA 4) without postoperative sequelae.

Surface analytical studies of maxillofacial implants: influence of the preoperational treatment and the human body on the surface properties of retrieved implants.

In the present work, surface analytical investigation of unimplanted as well as retrieved pyrolytic carbon-covered carbon/carbon composite implants and Ti osteosynthesis plates is reported. The Ti plates were covered by a 200-nm-thick, anodically and thermally formed TiO2 layer. Our results suggest that although the oxide layer on the Ti miniplates remained stable during the time spent in the human body, there is still material transport between the implant and the human body. In case of the carbon/carbon composite implants, damage of the carbon fibers constituting the material was found on one side of the sterile implant and attributed to the manufacturing process. The NaCl crystals originally present on the surface of the sterile material disappeared during the time spent in the human body. As a result of the interaction with the human body, a new surface layer (mainly constituted of carbon) appeared on the implant. The results indicate that both the time spent in the human organism and the preparation of the implants before operation can have detectable effects on the investigated surface properties. Surface analytical investigations could therefore provide information not only about the biocompatibility of these materials but also about the effect of their treatment before operation.

Reliability of anthropometric parameters in the prediction of the visceral fat area among adult women.

Visceral fat accumulation is a risk factor for cardiometabolic diseases. Magnetic resonance imaging (MRI) and computed tomography (CT) provided the most accurate techniques of abdominal fat assessment, but these methods are very expensive. The aim of this study was to examine and compare the predictive ability of simple anthropometric parameters for visceral fat area (VFA) among adult women in different age and obesity status groups. The sample consisted of 133 adult women (aged 18-76 years). All subjects underwent anthropometric measurements. Body composition and VFA were determined with a multi-frequency bioimpedance analyzer (BIA). 16.9% of the younger women (age < 45) were obese with a body-mass index (BMI) > or = 30.0 kg/m2, and 23.2% of the older individuals (age > 45) had BMI > or = 30 kg/m2. After age and BMI adjustment, the best correlation was observed between VFA and waist circumference (WC) in younger women (R = 0.347, p = 0.002). In the case of the older women, the best correlation efficient values were for SAD (R = 0.560, p < 0.001) and hip circumference (R = 0.550, p < 0.001). The partial correlation coefficients were consistently higher for younger subjects with excessive fat accumulation (overweight & obese subgroup; individuals with WC > 80 cm) compared to women without obesity. Results of the multiple linear stepwise regression analyses showed the significance of age and BMI in prediction of VFA. In addition, hip circumference (HC) was one of the methods that best reflected VFA in older women independently from obesity status. Using single anthropometric parameters is not usually sufficient for predicting with good accuracy the VFA, but the convenient combination of these parameters could be a suitable way for the reliable prediction in Hungarian women.