Contrast media dose, angiography timing, and acute renal failure after coronary operations

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Periodogram and likelihood periodicity search in the SNO solar neutrino data

In this work a detailed spectral analysis for periodicity search of the time series of the 8B solar neutrino flux released by the SNO Collaboration is presented. The data have been publicly released with truncation of the event times to the unit of day (1 day binning); they are thus suited to undergo the traditional Lomb-Scargle analysis for periodicity investigation, as well as an extension of such a method based on a likelihood approach. The results of the analysis presented here confirm the absence of modulation signatures in the SNO data. For completeness, a more refined "1 day binned" likelihood is also illustrated, which approximates the unbinned likelihood methodology, based upon the availability of the full time information, adopted by the SNO collaboration. Finally, this work is completed with two different joint analyses of the SNO and Super-Kamiokande data, respectively, over the common and the entire data taking periods. While both analyses reinforce the case of the constancy of the neutrino flux, the latter in addition provides evidence of the detection at the 99.7% confidence level of the annual modulation spectral line due to the Earth's orbit eccentricity around the SunComment: 27 pages, 29 figures. Joint periodicity analysis of the SNO and Super-Kamiokande data added. Accepted for publication on Phys. Rev.

Management of bleeding in cardiac surgery patients

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Validation of viscoelastic coagulation tests during cardiopulmonary bypass: comment

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Comparison of fibrin-based clot elasticity parameters measured by free oscillation rheometry (ReoRox (R)) versus thromboelastometry (ROTEM (R))

Background. Whole blood viscoelastic tests such as the fibrin-based thromboelastometry (ROTEM (R)) test FIBTEM are increasingly used in the perioperative setting to quickly identify deficits in fibrin quality, and to guide hemostatic therapy. The recently developed FibScreen2 test of the ReoRox (R) method, based on free oscillation rheometry, also provides an evaluation of fibrin clot quality. To date, little information is available on the performance of this test in hemodiluted blood, by comparison to FIBTEM. Methods. Whole blood samples from eight healthy volunteers were analyzed using FIBTEM and Fibscreen2. Native and diluted (to 33% and 50% using saline, gelatin or hydroxyethyl starch [HES]) samples were analyzed. Clot strength parameters, including FIBTEM maximum clot firmness (MCF), FIBTEM maximum clot elasticity (MCE) and Fibscreen2 maximum elasticity (G'max), were measured. Results. In repeatedly measured samples from two volunteers, FIBTEM MCF and Fibscreen2 G'max revealed a coefficient of variation (CV) of 5.3 vs. 16.3% and 5.6 vs. 31.7% for each volunteer, respectively. Hemodilution decreased clot strength. Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used. The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline. Finally, a regression analysis between FIBTEM MCE and Fibscreen2 G'max revealed a poor goodness of fit (r(2) = 0.37, p < 0.0001). Conclusions. ReoRox (R) Fibscreen2 test has a high coefficient of variation, and its application in various hemodilution conditions showed limited comparability with the ROTEM (R) FIBTEM test

Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome

INTRODUCTION: Hyperlactatemia during cardiopulmonary bypass is relatively frequent and is associated with an increased postoperative morbidity. The aim of this study was to determine which perfusion-related factors may be responsible for hyperlactatemia, with specific respect to hemodilution and oxygen delivery, and to verify the clinical impact of hyperlactatemia during cardiopulmonary bypass in terms of postoperative morbidity and mortality rate. METHODS: Five hundred consecutive patients undergoing cardiac surgery with cardiopulmonary bypass were admitted to this prospective observational study. During cardiopulmonary bypass, serial arterial blood gas analyses with blood lactate and glucose determinations were obtained. Hyperlactatemia was defined as a peak arterial blood lactate concentration exceeding 3 mmol/l. Pre- and intraoperative factors were tested for independent association with the peak arterial lactate concentration and hyperlactatemia. The postoperative outcome of patients with or without hyperlactatemia was compared. RESULTS: Factors independently associated with hyperlactatemia were the preoperative serum creatinine value, the presence of active endocarditis, the cardiopulmonary bypass duration, the lowest oxygen delivery during cardiopulmonary bypass, and the peak blood glucose level. Once corrected for other explanatory variables, hyperlactatemia during cardiopulmonary bypass remained significantly associated with an increased morbidity, related mainly to a postoperative low cardiac output syndrome, but not to mortality. CONCLUSION: Hyperlactatemia during cardiopulmonary bypass appears to be related mainly to a condition of insufficient oxygen delivery (type A hyperlactatemia). During cardiopulmonary bypass, a careful coupling of pump flow and arterial oxygen content therefore seems mandatory to guarantee a sufficient oxygen supply to the peripheral tissues

An adjusted EuroSCORE model for high-risk cardiac patients

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