The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

Purpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcirculation in neonates with severe respiratory failure. Methods. This single-center prospective observational pilot study took place in an intensive care unit of a level III university children's hospital. Twenty-one-term neonates, who received VA-ECMO treatment, were included. The microcirculation was assessed in the buccal mucosa, using Orthogonal Polarization Spectral imaging, within 24 hours before (T1) and within the first 24 hours after initiation of ECMO treatment (T2). Data were compared to data of a ventilated control group (N = 7). Results. At baseline (T1), median functional capillary density (FCD), microvascular flow index (MFI), and heterogeneity index (HI) did not differ between the ECMO group and the control group. At T2 the median FCD was lower in the control group (median [range]: 2.4 [1.4–4.2] versus 4.3 [2.8–7.4] cm/cm2; P value <0.001). For MFI and HI there were no differences at T2 between the two groups. Conclusion. The perfusion of the microcirculation does not change after initiation of VA-ECMO treatment in neonates with severe respiratory failure

Recent geospatial dynamics of Terceira (Azores, Portugal) and the theoretical implications for the biogeography of active volcanic islands

Ongoing work shows that species richness patterns on volcanic oceanic islands are shaped by surface area changes driven by longer time scale (>1 ka) geological processes and natural sea level fluctuations. A key question is: what are the rates and magnitudes of the forces driving spatial changes on volcanic oceanic islands which in turn affect evolutionary and biogeographic processes? We quantified the rates of surface-area changes of a whole island resulting from both volcanogenic flows and sea level change over the last glacial-interglacial (GI) cycle (120 ka) for the volcanically active island of Terceira, (Azores, Macaronesia, Portugal). Volcanogenic activity led to incidental but long-lasting surface area expansions by the formation of a new volcanic cone and lava-deltas, whereas sea level changes led to both contractions and expansions of area. The total surface area of Terceira decreased by as much as 24% per time step due to changing sea levels and increased by 37% per time step due to volcanism per time step of 10 ka. However, while sea levels nearly continuously changed the total surface area, volcanic activity only impacted total surface area during two time steps over the past 120 ka. The surface area of the coastal and lowland region (here defined as area <300 m) was affected by sea level change (average change of 11% / 10 ka for 120–0 ka) and intra-volcanic change (average change of 17% / 10 ka for 120–0 ka). We discuss the biogeographic implications of the quantified dynamics, and we argue that surface area change is mainly driven by volcanic processes in the early stages of the island’s life cycle, while during the later stages, area change becomes increasingly affected by sea level dynamics. Both environmental processes may therefore affect biota differently during the life cycle of volcanic oceanic islands.S.J.N. received funding from the Portuguese National Funds, through Fundação para a Ciência e a Tecnologia (FCT), within the project UID/BIA/00329/2013 and the Research Fellowship PD/BD/114380/2016. S.P.A. acknowledges his research contract (IF/00465/2015) funded by the Portuguese Science Foundation (FCT). C.S.M. is benefiting from a PhD grant M3.1.a/F/100/2015 from FRCT/Açores 2020 by Fundo Regional para a Ciência e Tecnologia (FRCT). Financial support to R.A. was received from the Laboratory of Excellence ‘TULIP’ (PIA-10-LABX-41). This work was supported by FEDER funds through the Operational Programme for Competitiveness Factors – COMPETE and by National Funds through FCT under the UID/BIA/50027/2013, POCI-01-0145-FEDER-006821 and under DRCT-M1.1.a/005/Funcionamento-C-/2016 (CIBIO-A) project from FRCT. This work was also supported by FEDER funds (in 85%) and by funds of the Regional Government of the Azores (15%) through Programa Operacional Açores 2020, in the scope of the project “AZORESBIOPORTAL – PORBIOTA”: ACORES‑01‑0145-FEDER-000072.info:eu-repo/semantics/publishedVersio

Increasing mean arterial blood pressure and heart rate with catecholaminergic drugs does not improve the microcirculation in children with congenital diaphragmatic hernia: a prospective cohort study

To study whether dopamine, norepinephrine, and epinephrine improve not only mean arterial blood pressure and heart rate but also microcirculatory perfusion in children with congenital diaphragmatic hernia. Prospective observational cohort study from November 2009 to July 2012. ICU of a level III university children's hospital. Twenty-eight consecutive congenital diaphragmatic hernia newborns of whom seven did not receive any catecholaminergic support and 21 received dopamine as the drug of first choice. Fourteen of the latter also received either norepinephrine or epinephrine in addition to dopamine. Twenty-eight healthy neonates, matched for gestational age, postnatal age, and gender, served as controls. None. Data were obtained before and after dopamine start and before and after norepinephrine or epinephrine start in case it was given. For the congenital diaphragmatic hernia without catecholaminergic support, data were obtained at admission days 1 and 2 and for the controls on day 1 of life. The buccal microcirculation was studied using Sidestream Dark Field imaging. Also macrocirculatory, respiratory, and biochemical variables were collected. Mean arterial blood pressure had improved after dopamine start, whereas the microcirculation had not. After the start of either norepinephrine or epinephrine, both blood pressure and heart rate had increased. However, the microcirculation failed to improve again. The microcirculation in the healthy controls was better than that in the congenital diaphragmatic hernia patients with catecholaminergic support. After cutoff values for abnormal microcirculation had been defined, abnormal microcirculation after dopamine start predicted the need for additional catecholaminergic support (area under the curve, 0.74-0.88; sensitivity, 77-77%; specificity, 69-77%). Likewise, microcirculatory impairment was associated with the need for extracorporeal membrane oxygenation. Catecholaminergic drug support with dopamine, norepinephrine, and/or epinephrine improved macrocirculatory function but did not improve the microcirculation in neonates with congenital diaphragmatic hernia. The microcirculation was not only impaired but it also predicted poor outcom

Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: a prospective observational cohort study

This study aimed to evaluate if the microcirculation is impaired during and after therapeutic hypothermia (TH) in children with return of spontaneous circulation after cardiac arrest (CA) and to assess if microcirculatory impairment predicts mortality. This has been reported for post-CA adults, but results might be different for children because etiology, pathophysiology, and mortality rate differ. This prospective observational cohort study included consecutive, non-neonatal post-CA children receiving TH upon intensive care admission between June 2008 and June 2012. Also included were gender-matched and age-matched normothermic, control children without cardiorespiratory disease. The buccal microcirculation was non-invasively assessed with Sidestream Dark Field Imaging at the start of TH, halfway during TH, at the start of re-warming, and at normothermia. Macrocirculatory, respiratory, and biochemical parameters were also collected. Twenty post-CA children were included of whom 9 died. During hypothermia, the microcirculation was impaired in the post-CA patients and did not change over time. At normothermia, the core body temperature and the microcirculation had increased and no longer differed from the controls. Microcirculatory deterioration was associated with mortality in the post-CA patients. In particular, the microcirculation was more severely impaired at TH start in the non-survivors than in the survivors - positive predictive value: 73-83, negative predictive value: 75-100, sensitivity: 63-100%, and specificity: 70-90%. The microcirculation is impaired in post-CA children during TH and more severe impairment at TH start was associated with mortality. After the stop of TH, the microcirculation improves rapidly irrespective of outcom

Solute Transport in Cyclically Deformed Porous Tissue Scaffolds with Controlled Pore Cross-Sectional Geometries

The objective of this study was to investigate the influence of pore geometry on the transport rate and depth after repetitive mechanical deformation of porous scaffolds for tissue engineering applications. Flexible cubic imaging phantoms with pores in the shape of a circular cylinder, elliptic cylinder, and spheroid were fabricated from a biodegradable polymer blend using a combined 3D printing and injection molding technique. The specimens were immersed in fluid and loaded with a solution of a radiopaque solute. The solute distribution was quantified by recording 20 μm pixel-resolution images in an X-ray microimaging scanner at selected time points after intervals of dynamic straining with a mean strain of 8.6 ± 1.6% at 1.0 Hz. The results show that application of cyclic strain significantly increases the rate and depth of solute transport, as compared to diffusive transport alone, for all pore shapes. In addition, pore shape, pore size, and the orientation of the pore cross-sectional asymmetry with respect to the direction of strain greatly influence solute transport. Thus, pore geometry can be tailored to increase transport rates and depths in cyclically deformed scaffolds, which is of utmost importance when thick, metabolically functional tissues are to be engineered

The National Coordinated Citrien eHealth Program to Scale Up Telemonitoring:Protocol for a Before-and-After Evaluation Study

Background: Sustainable implementation of telemonitoring in health care is challenging, especially if one aims to scale up telemonitoring initiatives nationwide. The National collaborative eHealth program in the Netherlands is supporting the nationwide upscaling of telemonitoring in 3 clinical domains by implementing telemonitoring in all Dutch university medical centers (UMCs). The chosen telemonitoring concepts are (1) telemonitoring solutions in the domain of cardiology, (2) telemonitoring solutions providing care from a distance in obstetrics, and (3) telemonitoring solutions monitoring vital functions in hospital wards. Objective: The aim of this study is to evaluate the upscaling of telemonitoring in Dutch university hospitals in order to gain a better knowledge of the process, methods, and outcomes of nationwide upscaling strategies. Our hypothesis is that by the completion of the Citrien program’s scale-up, telemonitoring will be operational in all UMCs but not normalized in routine care. Methods: A before-and-after study will be conducted to assess upscaling. The theoretical frameworks used are the framework for nonadoption, abandonment, scale-up, spread, and sustainability; the Normalization Process Theory; and a project management tool Project Canvas. The primary outcome of the study is the degree of normalization to which health care providers at UMCs consider telemonitoring a part of their routine practice, measured using the Normalization MeAsurement Development tool (NoMAD). Our secondary outcome is the uptake of telemonitoring at the Dutch UMCs, using management data from UMCs’ business intelligence systems query. Results: Data will be collected between May 2020 and December 2022. Results were retrieved in June 2023. UMCs’ business intelligence systems are queried for data for the secondary outcome measures. There is a risk that the UMCs will not be able to provide this management information. The laws and regulations governing telemonitoring in the Netherlands are changing, with the Electronic Data Exchange in Health Care Act (Wet elektronische gegevensuitwisseling in de zorg) and the European Health Data Space Act expected to positively influence implementation and upscaling. Conclusions: The Citrien program is a nationally coordinated change management program that is scaling up telemonitoring across contexts and settings. This study will produce original data on the uptake and upscaling of telemonitoring at Dutch UMCs. Future initiatives to implement eHealth in the health care sector may be guided by the wide range of success factors, obstacles, and experiences collected through this program. The network itself may be of great value impacting future acceleration of eHealth initiatives