Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content

Effect of Montelukast on Spinal Cord Ischemia- Reperfusion Injury

AmAÇ: Çalışma, deneysel bir modelde, seçici tersinir bir CysLT1 reseptör antagonisti olan montelukastın, spinal kord iskemi-reperfüzyon (I/R) hasarı üzerindeki rolünü incelemek için tasarlandı. yÖntem ve GereÇler: Yirmi bir erkek Sprague-Dawley tipi sıçan, rasgele üç gruba (her grupta n 7) ayrıldı; G1 (aort oklüzyonu ve montelukast uygulaması yok), G2 (45 dakika aort oklüzyonu; montelukast uygulaması yok) ve G3 (45 dk aort oklüzyonu, 10 mg / kg montelukast uygulaması).Reperfüzyonun 48. saatindeki Motor Defisit Indeksi (MID) skorlaması kullanılarak yapılan nörolojik değerlendirmeden sonra, lomber spinal kordlar, histopatolojik değerlendirme ve HSP70, interlökin-6 ve miyeloperoksidaz (MPO) için immünhistokimyasal boyama amacıyla çıkartıldı. BulGulAr: G1 grubundaki tüm sıçanların nörolojik durumu normaldi ve MDI skorları 0\'dı (p 0.05). G3\'ün MDI skoru, G2 grubuna göre anlamlı derecede düşük bulundu (2.8 vs 5.5; p 0.05 ). G1'de vaküoler konjesyon, diğer gruplara göre anlamlı derecede düşük bulundu (p 0.0001). İnterlökin-6 reseptörü düzeyi, G3 grubunda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde daha düşük bulundu (p 0.013). HSP70 ve MPO boyanma derecesi açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu. Postiskemik organlarda lökotrienlerin artan üretimi, I/R hasarında önemli bir rol oynamaktadır. sOnuÇ: Çalışmanın bulguları, montelukastın motor iyileşmeyi geliştirdiğini ve spinal kordun I/R hasarında IL-6 düzeylerini azalttığını göstermiştir.AIm: Paraplegia due to ischemia-reperfusion (I/R) injury of the spinal cord is a devastating complication of thoracoabdominal aortic surgery. Cysteinyl leukotrienes are potent mediators of inflammation that are associated with I/R injury. The present study was designed to investigate the role of montelukast, a selective reversible CysLT1 receptor antagonist, on spinal cord I/R injury in an experimental model. mAterIAl and methOds: Twenty-one male Sprague-Dawley rats were randomly assigned to three groups (n7 per group) as G1 (no aortic occlusion and montelukast administration), G2 (45 min. aortic occlusion; no montelukast administration) and G3 (45 min. aortic occlusion, 10 mg/kg montelukast administration). After neurologic evaluation using the Motor Deficit Index (MDI) score at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathological evaluation and immunohistochemical staining for HSP70, interleukin-6 and myeloperoxidase (MPO). results: All rats in the G1 group had a normal neurological status and their MDI score was 0 (p<0.05). The MDI score of G3 was significantly lower than G2 group (2.8 vs. 5.5; p<0.05). Vacuolar congestion was found to be significantly lower in G1 than the other groups (p0.0001). The interleukin-6 receptor level was found to be significantly lower in G3 group than the control group (p0.013). There was no statistically significant difference found among the groups in terms of the degree of HSP70 and MPO staining. COnClusIOn: Increased generation of leukotrienes in postischemic organs play an important role in I/R injury. The findings of the current study demonstrated that montelukast improved motor recovery and decreased IL-6 levels in spinal cord I/R injury

Effect of heparin on neuroprotection against spinal cord ischemia and reperfusion in rats

Ankarali, Handan Camdeviren/0000-0002-3613-0523; Budak, Ali Baran/0000-0002-9772-1765WOS: 000319225600015PubMed: 23467953BACKGROUND: Paraplegia due to ischemia/reperfusion (I/R) injury of the spinal cord is a devastating and undesired complication of thoraco-abdominal aortic surgery. Unidentified clots cause a variety of thromboembolic events and deteriorate the severity of ischemia. We investigated the effect of the degree of anticoagulation on spinal cord I/R injury and whether heparin is protective against I/R injury beside its anticoagulant properties. MATERIALS AND METHODS: Twenty-eight rats were randomly assigned to four groups (n=7 per group) as G1 (no aortic occlusion and heparin administration), G2 (45 min aortic occlusion; no heparin administration), G3 (45 min aortic occlusion; 400 IU/kg heparin to keep activated clotting time (ACT) level around 200 sec), and G4 (45 min aortic occlusion; 800 IU/kg heparin to keep ACT level around 600 sec). After neurologic evaluation at the 48th hour of reperfusion, lumbar spinal cords were removed for histopathologic evaluation and immunohistochemical staining for HSP70 (heat shock protein 70), interleukin-6 and myeloperoxidase (MPO). RESULTS: The Motor Deficit Index (MDI) scores were lowest in G1 group (p < 0.05) and the MDI scores of G3 and G4 were significantly lower than G2 group (p < 0.05). The neuronal degeneration in G3 was significantly lower than the other groups, respectively (p = 0.03). Histopathological evaluation showed no significant intergroup differences in terms of the degree of edema and inflammatory response. There was no statistically significant difference found among the groups in terms of HSP70 staining, IL-6 staining or the degree of MPO staining. CONCLUSIONS: Protection of spinal cord from I/R injury requires a multimodal management. We should not miss out the importance of adequate anticoagulation in thoraco-abdominal surgical procedures. Furthermore, the recently discovered anti-inflammatory property of glycosaminoglycans, including heparin, deserves to be investigated

Minimally Invasive Aortic Valve Replacement on Minimally Invasive Extracorporeal Circulation: Going beyond Aesthetics

We present our multidisciplinary and multistep strategy in patients undergoing minimally invasive aortic valve replacement (mAVR) on minimally invasive extracorporeal circulation (MiECC) compared with control groups of a single strategy and conventional techniques. This cohort study included high-risk patients (Society of Thoracic Surgeons [STS] risk score \u3e8%) undergoing aortic valve surgery under different strategies during the period from January 2017 until March 2019. Patients were matched for age, gender, body mass index, and STS score: group 1 (MiAVR) based on a minimally invasive technique with J-mini-sternotomy, rapid deployment valve (RDV), and type IV customized MiECC; group 2 (control-mAVR) consisted of minimally invasive technique with only J mini-sternotomy and RDV on a conventional extracorporeal system; group 3 (control-MiECC): full sternotomy and type IV customized MiECC; and group 4 (control): full sternotomy on a conventional extracorporeal system. The MiAVR group had significantly less duration of x-clamp time (35.4 ± 11 minutes), postoperative respiratory support (4.1 ± 1 hour), postoperative hemorrhage (250 ± 50 mL), and intensive care unit stay (1 ± .5 days) than the control-conventional (group 4) group. Seventy-six percent of patients did not receive any blood products in MiAVR (p = .025 vs. group 4). Incidence of atrial fibrillation (8%) and low cardiac output (14%) in MiAVR were significantly better than control. Critics of minimally invasive techniques sustain that potential advantages are offset by a longer cross-clamp and cardiopulmonary bypass duration, which may translate into inferior clinical outcomes. We advocate that our multidisciplinary approach supported by multiple technologies may be associated with faster recovery and superior outcomes than conventional minimally/conventional techniques

Montelukastın karaciğer ve böbrekteki iskemi/reperfüzyon hasarına olan etkisi

Amaç: Torakoabdominal aort anevrizması cerrahisinin sebep olabildiği splanknik iskemi, karaciğer ve/veya böbrek hasarının neden olduğu ciddi postoperatif komplikasyonlarla sonuçlanabilir. Bu çalışmada seçici tersinir bir CysLT1 reseptör antagonisti olan montelukastın, aortanın geçici oklüzyonuyla yaratılan böbrek ve karaciğer iskemi-reperfüzyon (I/R) hasarı üzerindeki koruyucu etkisini incelemek için tasarlandı.Gereç ve Yöntemler: Yirmi bir erkek Sprague-Dawley tipi sıçan, rasgele üç gruba (her grupta n7) ayrıldı; G1 (aort oklüzyonu ve montelukast uygulaması yok), G2 (45 dakika aort oklüzyonu; montelukast uygulması yok) ve G3 (45 dakika aort oklüzyonu, 10 mg/kg montelukast uygulaması). Reperfüzyonun 48. saatinde böbrek ve karaciğerden alınan doku örneklerinden histopatolojik değerlendirme ve HSP 70, interlökin-6 ve miyeloperoksidaz (MPO) ile immünohistokimyasal boyama yapıldı.Bulgular: Böbrekten alınan doku örnekleri tübüler hücre dejenerasyonu, sitoplazmik vakuol formasyonu, hemoraji ve tübüler dilatasyon açısındna incelendi ve gruplar arasında istatistiksel olarak anlamlı fark bulundu (P 0.001, P 0.017, P 0.001). G1 ve G3 gruplarında HSP-70 ile boyanmada G2 ye göre anlamlı fark saptandı (P 0.001). G3 karaciğer örneklerinde hepatosit dejenerasyonu G1 ve G2 den anlamlı olarak düşüktü (P 0.027).Sonuçlar: Yapılan çalışmanın bulguları, montelukastın böbrek ve karaciğer üzerinde koruyucu etkileri olduğunu histopatolojik ve immünohistokimyasal olarak göstermiştir. Montelukastın koruyucu etkileri, ilacın antioksidan ve antiinflamatuar etkilerine bağlanabilirAim: The thoracoabdominal aortic aneurysm surgery may cause splanchnic ischemia and may result in severe postoperative complications caused by liver and/or kidney injury. This study investigated the effect of temporary occlusion of the aorta on the development of I/R injury of liver and kidney and the protective effect of montelukast, a selective reverse CysLT1 receptor antagosit. Material and Methods: Twenty-one male Sprague-Dawley rats were randomly assigned to three groups (n7 per group) as G1 (no aortic occlusion and montelukast administration), G2 (45 min. aortic occlusion; no montelukast administration) and G3 (45 min. aortic occlusion, 10 mg/kg montelukast administration). At the 48th hour of reperfusion, kidney and liver samples were dissected for histopathological evaluation and immunohistochemical staining for HSP70, interleukin-6 and myeloperoxidase (MPO). Results: Tissue samples taken from the kidney showed significant intergroup differences in terms of tubular cell degeneration, cytoplasmic vacuole formation, hemorrhage and tubular dilatation (P 0.001, P 0.017, P 0.001, P 0.001 respectively). There was a significant difference with regards to HSP-70 stain (P 0.01) in favor of G1 and G3 with respect to G2. Hepatocyte degeneration in the liver samples of G3 was significantly lower than that of G1 and G2 (P 0.027).Conclusion: The findings of the current study demonstrated that montelukast has protective effects on both kidney and liver; and were confirmed histopathologically and immunohistochemically. The protective effects of montelukast can be attributed to its potential of anti-oxidative and anti-inflammatory action

How DMSO, a widely used solvent, affects spinal cord injury

The aim of this experimental study was to investigate whether dimethylsulfoxide (DMSO) has protective effects on spinal cord ischemia-reperfusion (I/R) injury. New Zealand rabbits were enrolled in the study. In addition to the control group, the study group received 0.1 mL/kg DMSO prior to ischemia. Blood samples were taken to obtain nitrite-nitrate levels during the surgical procedure. After neurological evaluation at 24 hr of reperfusion, lumbar spinal cords were removed for electron microscopic evaluation and malondialdehyde and myeloperoxidase measurements. The mean Tarlov score of the DMSO group was higher than that of the control group. Electron microscopic examination was carried out with tissue samples at 24 hr of reperfusion. The DMSO group had better preservation with the electron microscopic scoring compared to the control group. Malonclialdehyde and myeloperoxidase levels were decreased in the DMSO group compared to the control group. Nitrite-nitrate levels were also lower in the DMSO group compared to control at 5 and 30 min of reperfusion. This study demonstrates a considerable neuroprotective effect of DMSO on neurological, biochemical, and histopathological analyses during periods of spinal cord I/R injury in rabbits. Although there was a difference between the DMSO and control groups in all measured parameters in our study, this was not statistically significant. DMSO deserves further investigation related with spinal cord ischemia and reperfusion. We should also consider the effect of DMSO when we use it as a solvent or vehicle during experimental I/R models