The use of indomethacin in the treatment of plateau waves : effects on cerebral perfusion and oxygenation

OBJECT: Plateau waves are sudden and steep increases in intracranial pressure (ICP) that can develop in patients with cerebral injuries, reduced pressure-volume compensatory reserve, and preserved autoregulation. They are caused by cerebral vasodilation in response to a reduction in cerebral perfusion and are associated with increased cerebral blood volume and reduced cerebral blood flow. The authors evaluated the hypothesis that administration of indomethacin, a potent cerebral arteriolar vasoconstrictor, could interrupt the vicious cycle that occurs during plateau waves, extinguishing these waves and, ultimately, restoring cerebral perfusion and oxygenation. METHODS: Plateau waves developed in nine patients, seven with severe traumatic brain injury and two with intraparenchymal hemorrhage. One to four episodes of plateau waves per patient were treated with indomethacin (15-20 mg), which was delivered by an intravenous bolus injection. Each patient's mean arterial blood flow (MABP), ICP, cerebral perfusion pressure (CPP), and cerebral tissue PO2 were continuously monitored and the data obtained were stored in a personal computer. Each patient's jugular venous O2 saturation (SjvO2) and venoarterial difference in PCO2 were evaluated by intermittent blood sampling. During five episodes of plateau waves, middle cerebral artery flow velocities were evaluated by transcranial Doppler ultrasonography. Indomethacin extinguished all plateau waves. On average, the ICP decreased from an initial value of 58.9 +/- 11.6 mm Hg to 21.2 +/- 8.6 and 25.8 +/- 13.7 mm Hg after 5 and 10 minutes, respectively (p < 0.01). The MABP did not change significantly. As a consequence the CPP increased by 98 and 81% after 5 and 10 minutes, respectively (p < 0.01). Five and 10 minutes after indomethacin was administered, SjvO2 increased from an initial value of 50 +/- 10.5% to 62 +/- 7.6 and 59.9 +/- 9.3%, respectively (p < 0.01); the cerebral tissue PO2 increased from an initial value of 13.4 +/- 10.6 mm Hg to 23.6 +/- 9.58 and 21.9 +/- 9.2 mm Hg, respectively (p < 0.05); and the venous-arterial PCO2 decreased significantly. The mean and diastolic flow velocities increased significantly, whereas the pulsatility index decreased from 1.39 +/- 0.56 to 1.09 +/- 0.4 at 5 minutes and 1.06 +/- 0.36 at 10 minutes (p < 0.05). CONCLUSIONS: The findings confirm that plateau waves are caused by vasodilation and show that indomethacin, by constricting the cerebral arteries, is effective in extinguishing plateau waves, ultimately restoring cerebral perfusion and oxygenation

Right ventricular failure after left ventricular assist device insertion: preoperative risk factors.

Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart Corp., Ottawa, ON, Canada). We compared the data from the patients who developed right ventricular failure and the patients who did not. Right ventricular failure occurred in 16\% of the patients. There was no significant difference between the groups in demographic characteristics. We identified as preoperative risk factors the pre-operative low mean pulmonary artery and the impairment of hepatic and renal function on laboratory data. Our results confirm in part the findings of the few previous studies. This information may be useful for the patient selection for isolated left ventricular assist device implantation, but other studies are necessary before establishing criteria for patient selection for univentricular support universally accepted

Antiphospholipid antibodies and neurological complications after pulmonary endarterectomy

Pružatelji mrežnih usluga uglavnom nemaju uvid u iskustvenu kvalitetu krajnjih korisnika usluge YouTube zbog toga što je sav promet šifriran. Obzirom na te uvjete, pružatelji mrežnih usluga obično ne mogu otkriti KPI-jeve kao što su početno kašnjenje, zaustavljanje videa ili promjene kvalitete iz prometa koji prolazi kroz njihove mreže. Na Fakultetu elektrotehnike i računarstva izrađeno je mnogo eksperimenata kako bi se razvila rješenja za procjenu iskustvene kvalitete i ključnih indikatora performansi za strujanje videa iz šifriranog prometa. Ti su pokusi napravljeni u kontroliranom ili stvarnom okruženju. Tijekom analize skupa podataka, gdje je skup podataka niz eksperimenata, bilo je mnogo ponavljajućeg rada. Drugi je problem bio u organiziranom pohranjivanju podataka i nedostatku alata za učinkovit pristup, spajanje i filtriranje podataka. Cilj ovog diplomskog rada bio je razviti web aplikaciju koja će riješiti navedene probleme. Vrijeme za analizu skupova podataka bit će značajno smanjeno s razvijenom aplikacijom Auto-A Storage jer će se sva obrada podataka obavljati automatski. Ova aplikacija će pružiti prilagođeno rješenje za pohranu svih mjernih podataka. Neke od glavnih značajki Auto-A Storage-a su spremanje, uređivanje, preuzimanje i filtriranje skupova podataka, kao i preuzimanje generiranih podataka spremnih za strojno učenje. Implementirana je provjera autentikacije i autorizacije tako da nitko ne može pristupiti Auto-A Storage-u bez dozvole administratora aplikacije. Korisnično sučelje Auto-A Storage-a implementirano je u JavaScript biblioteci React, dok je back-end implementiran u Spring Boot-u, u programskom jeziku Java.Network providers for the most part lack insight into YouTube end-users' QoE because of traffic encryption. Given these conditions, network providers usually cannot detect KPIs like initial delay, stalling events or quality switches from the traffic passing through their networks. At the Faculty of Electrical Engineering and Computing, University of Zagreb, a lot of experiments were performed to collect both application and network data, and develop machine learning-based solutions for estimating video streaming QoE/KPIs from encrypted traffic. Those experiments were performed in a controlled or a real environment. During dataset analysis, where a dataset is a collection of experiments, there was a lot of repetitive work. Another problem was related to storing data in an organized way, and lack of tools for efficient access, merging, and filtering of the data. As a result, the aim of this thesis was to develop a web application that could solve listed problems. The time to analyze datasets will be significantly reduced with developed application Auto-A Storage since all processing of the data will be done automatically.the This application will provide a customized solution for storage for all measurement data. Some of the main features of Auto-A Storage are storing, editing, downloading, and filtering of datasets, as well as downloading generated ML-ready data. It has implemented authentication and authorization so nobody can access to Auto-A Storage without application administrators' permission. The front-end of Auto-A Storage was implemented in React, a JavaScript library, while the back-end was implemented in Spring Boot, a Java framework

[D-Ala2,D-Leu5]-enkephalin (DADLE) and morphine-induced postconditioning by inhibition of mitochondrial permeability transition pore, in human myocardium

The aim of the study was to examine the cardioprotective effect of morphine and Delta 2 opioid d-Ala2-Leu5 enkephalin (DADLE) administered, at early reoxygenation, in isolated human myocardium exposed to hypoxia-reoxygenation. Then, we tested the involvement of mitochondrial permeability transition pore in morphine and DADLE-induced postconditioning. Human right atrial trabeculae were obtained during cardiac surgery (coronary artery bypass and aortic valve replacement). Isometrically contracting isolated human right atrial trabeculae were exposed to 30-min hypoxia and 60-min reoxygenation (control group). In treatment groups, morphine 0.5 \u3bcmol, DADLE 10 nmol, DADLE 50 nmol and DADLE 100 nmol were administered during the first 15 min of reoxygenation. In two additional groups, morphine and DADLE 100 nmol were administered in the presence of atractyloside 50 \u3bcmol, the mitochondrial permeability transition pore opener. The force of contraction at the end of 60-min reoxygenation period (FoC(60) expressed as % of baseline) was compared (mean \ub1 standard deviation) between the groups by an analysis of variance. Morphine (FoC(60): 81 \ub1 9% of baseline), DADLE 50 nmol (FoC(60): 76 \ub1 11% of baseline) and DADLE 100 nmol (FoC(60): 81 \ub1 4% of baseline) increased significantly (P < 0.001) the FoC(60) as compared with the control group (FoC(60): 53 \ub1 3% of baseline). DADLE 10 nmol did not modify the FoC(60) (50 \ub1 9% of baseline; P = 0.60 versus control group). The enhanced recovery of FoC(60) induced by morphine and DADLE 100 nmol were abolished in the presence of atractyloside (FoC(60): respectively 57 \ub1 6% and 44 \ub1 7% of baseline; P < 0.001). In conclusion, the administration of morphine and DADLE, in early reoxygenation period, protected human myocardium, in vitro, against hypoxia-reoxygenation injury, at least in part, by the inhibition of mitochondrial permeability transition pore opening

Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study

Abstract Introduction Unintentional dural puncture (UDP) occurs in 0.5–1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. Methods This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. Results Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. Conclusion Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization