Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved

The impact of heparin coated circuits upon metabolism in vital organs:Effect upon cerebral and renal function during and after cardiopulmonary bypass

During cardiopulmonary bypass (CPB), the brain and the kidneys may be damaged because of microemboli, ischemia, and inflammation. The latter has been reduced by the use of heparin coated circuits. We questioned whether heparin coated circuits could also reduce cerebral and renal damage and whether inflammatory markers correlate with damage to the brain and the kidneys. Fifty-one patients scheduled for coronary artery bypass grafting were perfused with either a heparin coated or an uncoated circuit. To compare the effect of a heparin coated circuit with an uncoated circuit upon cerebral and renal function in relation to inflammation, we assessed markers of cerebral (S100beta) and renal (N-acetyl-beta-D-glucosaminidase [NAG], creatinine, and urea) function, inflammation, and oxygen metabolism. S100beta levels and NAG levels increased during CPB in both groups as compared with baseline levels (p <0.01), without differences between the groups. After 15 minutes on CPB, C4b/c levels were significantly higher in the coated group compared with the uncoated group (p <0.02). C4b/c correlated with S100beta (p <0.01). Total body oxygen delivery (DO2) and consumption (VO2) decreased significantly in both groups during CPB (p <0.01), but recovery was better in the coated group. After protamine infusion, total body oxygen delivery and consumption correlated negatively with S100beta levels (both p <0.05) and with NAG levels (both p <0.01). This study suggests that, if adequate tissue perfusion is not maintained, the use of a heparin coated circuit gives no additional benefit beyond that of the uncoated circuit. The inverse relationship of both cerebral and renal markers with DO2 and VO2 suggests that increased levels of S100beta and NAG during CPB may primarily be caused by an oxygen deficit and secondary to the inflammatory response

Floating nematic phase in colloidal platelet-sphere mixtures

The phase behaviour of colloidal dispersions is interesting for fundamental reasons and for technological applications such as photonic crystals and electronic paper. Sedimentation, which in everyday life is relevant from blood analysis to the shelf life of paint, is a means to determine phase boundaries by observing distinct layers in samples that are in sedimentation-diffusion equilibrium. However, disentangling the effects due to interparticle interactions, which generate the bulk phase diagram, from those due to gravity is a complex task. Here we show that a line in the space of chemical potentials µ(i), where i labels the species, represents a sedimented sample and that each crossing of this sedimentation path with a binodal generates an interface under gravity. Complex phase stacks can result, such as the sandwich of a floating nematic layer between top and bottom isotropic phases that we observed in a mixture of silica spheres and gibbsite platelets

Phase Transitions in Colloidal Suspensions of Virus Particles

Colloidal liquid crystals are a useful experimental system for studying fun-damental aspects of liquid crystal ordering, because the time, energy, and size scales involved allow one to interact with the system with laboratory scale probes and forces, in a way that is not possible in small molecul