In silico testing of the semi-closed loop infusion system with a new simulator

Goal directed fluid therapy (GDFT) implies the flow-related parameters guided infusion of fluids. It requires adherence to complex clinical algorithms and fluid protocols, as well as simultaneous monitoring of several parameters and evaluation of their fluid responsiveness or actual response to fluid challenges. Automated clinical decision support systems (ACDSS) are used to ease the task. However, they are based on the flow-related (hemodynamic) parameters – arterial blood pressure, cardiac output, etc. Meanwhile, infusions guided by hemodynamic endpoints may lead to edema. A mini Volume Loading Test (mVLT) may be helpful in detection of imminent edema from changes in hemodilution during stepwise infusion which is conventionally used for hemodynamic optimization. We developed an ACDSS which is based on evaluation of both hemodynamic and hemodilution parameters. It operates on the basis of our unique algorithm which implies interchangeable application of fluid loading, vasopressor injection and red cell transfusion. This ACDSS is used in our PC-based command centre of a prototype semi-closed loop (SCL) infusion system. We developed a simulator – ‘Virtual Patient’ – on the basis of our previous clinical records aiming to test a new controller, as well as train the research team before starting a clinical trial. In silico testing continued for 12 hours on five occasions. Primary endpoint was the compliance of a controller with our clinical algorithm and the stability of operation in a spectrum of arterial hypotension and bleeding scenarios. The prototype SCL infusion system was found ready for clinical validation

Unexpected Mitral Regurgitation During Coronary Artery Bypass Graft Surgery: The Multidisciplinary Management of a Mitral Valve Cleft.

Fernando, R. J., Johnson, S. D., Patel, P. A., Gutsche, J. T., Lauter, D., Feinman, J. W., Guelaff, E., Weiss, S. J., Richardson, K. M., Boisen, M. L., Gelzinis, T. A., & Augoustides, J. G. (2018). Unexpected Mitral Regurgitation During Coronary Artery Bypass Graft Surgery: The Multidisciplinary Management of a Mitral Valve Cleft. Journal of cardiothoracic and vascular anesthesia, 32(3), 1480–1486. https://doi.org/10.1053/j.jvca.2017.09.00

An ontological foundation for ocular phenotypes and rare eye diseases

Background: The optical accessibility of the eye and technological advances in ophthalmic diagnostics have put ophthalmology at the forefront of data-driven medicine. The focus of this study is rare eye disorders, a group of conditions whose clinical heterogeneity and geographic dispersion make data-driven, evidence-based practice particularly challenging. Inter-institutional collaboration and information sharing is crucial but the lack of standardised terminology poses an important barrier. Ontologies are computational tools that include sets of vocabulary terms arranged in hierarchical structures. They can be used to provide robust terminology standards and to enhance data interoperability. Here, we discuss the development of the ophthalmology-related component of two well-established biomedical ontologies, the Human Phenotype Ontology (HPO; includes signs, symptoms and investigation findings) and the Orphanet Rare Disease Ontology (ORDO; includes rare disease nomenclature/nosology). Methods: A variety of approaches were used including automated matching to existing resources and extensive manual curation. To achieve the latter, a study group including clinicians, patient representatives and ontology developers from 17 countries was formed. A broad range of terms was discussed and validated during a dedicated workshop attended by 60 members of the group. Results: A comprehensive, structured and well-defined set of terms has been agreed on including 1106 terms relating to ocular phenotypes (HPO) and 1202 terms relating to rare eye disease nomenclature (ORDO). These terms and their relevant annotations can be accessed in http://www.human-phenotype-ontology.org/ and http://www.orpha.net/; comments, corrections, suggestions and requests for new terms can be made through these websites. This is an ongoing, community-driven endeavour and both HPO and ORDO are regularly updated. Conclusions: To our knowledge, this is the first effort of such scale to provide terminology standards for the rare eye disease community. We hope that this work will not only improve coding and standardise information exchange in clinical care and research, but also it will catalyse the transition to an evidence-based precision ophthalmology paradigm