Systematic Review of Emotion Detection with Computer Vision and Deep Learning.

Emotion recognition has become increasingly important in the field of Deep Learning (DL) and computer vision due to its broad applicability by using human-computer interaction (HCI) in areas such as psychology, healthcare, and entertainment. In this paper, we conduct a systematic review of facial and pose emotion recognition using DL and computer vision, analyzing and evaluating 77 papers from different sources under Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our review covers several topics, including the scope and purpose of the studies, the methods employed, and the used datasets. The scope of this work is to conduct a systematic review of facial and pose emotion recognition using DL methods and computer vision. The studies were categorized based on a proposed taxonomy that describes the type of expressions used for emotion detection, the testing environment, the currently relevant DL methods, and the datasets used. The taxonomy of methods in our review includes Convolutional Neural Network (CNN), Faster Region-based Convolutional Neural Network (R-CNN), Vision Transformer (ViT), and "Other NNs", which are the most commonly used models in the analyzed studies, indicating their trendiness in the field. Hybrid and augmented models are not explicitly categorized within this taxonomy, but they are still important to the field. This review offers an understanding of state-of-the-art computer vision algorithms and datasets for emotion recognition through facial expressions and body poses, allowing researchers to understand its fundamental components and trends.

Is Negative Affect that Bad? The Effect of Affective States on Conventional and Unconventional Creative Thinking in University Students.

Introduction: The role of affective states on the creative process has been receiving the attention of researchers and has led to contradictory results. Most research in creativity has emphasized the role of affective states, mainly positive ones, on creativity levels, namely those resulting from divergent thinking tasks that reveal the unconventional way of thinking in the creative process. However, there are no studies to date that focus on the impact of affective states on conventional and unconventional thinking, during the same creative process, which consider a single creative assessment task. The aim of this experimental study was to analyze the effect of induced affective states on both conventional and unconventional thinking of creativity in adults by using the TCT-DP (Test for Creative Thinking-Drawing Production). Method: Seventy-five university students, mostly female, with a mean age of 26.95 years, were randomly assigned into three affect elicitation conditions (pleasant vs. unpleasant vs. neutral). Results: Results indicated that the negative affective state led to higher levels of conventional thinking when compared to positive and neutral affective states. However, no significant differences were found on unconventional thinking across the three conditions. Conclusions: Our results do not support the assumption that the negative affect has a hindering effect on creativity nor the positive affect increases creativity. Negative affect seems to promote conventional thinking, perhaps due to its cognitive correlates, which can be manifested in focusing attention and analytic thinking. Practical and theoretical implications for future research on the role of affective states on creativity are discussed.

Introducción: El papel de los estados afectivos en el proceso creativo ha sido objeto de atención por parte de los investigadores y ha dado lugar a resultados contradictorios. La mayor parte de la investigación en creatividad ha hecho hincapié en el papel de los estados afectivos, principalmente los positivos, sobre los niveles de creatividad. A saber, los resultantes de las tareas de pensamiento divergente que revelan la forma no convencional de pensar en el proceso creativo. Este estudio tuvo como objetivo analizar el efecto de los estados afectivos inducidos en dos dimensiones distintas del pensamiento creativo en adultos. Método: Setenta y cinco voluntarios, en su mayoría mujeres, con una edad media de 26.95 años, fueron asignados aleatoriamente a tres condiciones de elicitación de estados afectivos (agradable vs desagradable vs neutral), justo antes de realizar una tarea de creatividad figurativa. Resultados: Los resultados indicaron que el estado afectivo negativo condujo a niveles más altos de pensamiento convencional. Conclusiones: Nuestros resultados no apoyan ni la hipótesis de que el afecto negativo tiene un efecto perjudicial sobre la creatividad ni la de que el afecto positivo aumenta la creatividad. El afecto negativo parece promover el pensamiento convencional, quizá debido a sus correlatos cognitivos, que pueden manifestarse en la atención focalizada y el pensamiento analítico. Se discuten las implicaciones prácticas y teóricas para futuras investigaciones sobre el papel de los estados afectivos en la creatividad.

High levels of pro-inflammatory SARS-CoV-2-specific biomarkers revealed by in vitro whole blood cytokine release assay (CRA) in recovered and long-COVID-19 patients.

BACKGROUND: Cytokines induced by SARS-CoV-2 infection play a crucial role in the pathophysiology of COVID-19 and hyperinflammatory responses have been associated with poor clinical outcomes, with progression to severe conditions or long-term subacute complications named as long-COVID-19. METHODS: In this cross-sectional study, we aimed to evaluate a set of antigen-specific inflammatory cytokines in blood from recovered COVID-19 individuals or who suffered a post-acute phase of SARS-CoV-2 infection compared to healthy individuals with no history of COVID-19 exposition or infection. Interferon-gamma (IFN-γ), IFN-γ-induced protein 10 (IP-10), tumor necrosis factor (TNF), IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, and IL-17A were quantified by multiplex cytometric bead assay and enzyme-linked immunosorbent assay after stimulation of whole blood with recombinant Spike protein from SARS-CoV-2. Additionally, all participants have evaluated for anti-(S) protein-specific IgG antibodies. Clinical specimens were collected within two months of COVID-19 diagnosis. RESULTS: A total of 47 individuals were enrolled in the study, a median age of 43 years (IQR = 14.5), grouped into healthy individuals with no history of infection or exposure to SARS-CoV-2 (unexposed group; N = 21); and patients from the Health Complex of the Rio de Janeiro State University (UERJ), Brazil, who were SARS-CoV-2 positive by RT-PCR (COVID-19 group)-categorized as recovered COVID-19 (N = 11) or long-COVID-19 (N = 15). All COVID-19 patients presented at least one signal or symptom during the first two weeks of infection. Six patients were hospitalized and required invasive mechanical ventilation. Our results showed that COVID-19 patients had significantly higher levels of IFN-γ, TNF, IL-1ß, IL-2, IL-6, IL-8, and IP-10 than the unexposed group. The long-COVID-19 group has presented significantly high levels of IL-1ß and IL-6 compared to unexposed individuals, but not from recovered COVID-19. A principal-component analysis demonstrated 84.3% of the total variance of inflammatory-SARS-CoV-2 response in the first two components, and it was possible to stratify IL-6, TNF, IL-1ß, IL-10, and IL-2 as the top-five cytokines which are candidates to discriminate COVID-19 group (including long-COVID-19 subgroup) and healthy unexposed individuals. CONCLUSION: We revealed important S protein-specific differential biomarkers in individuals affected by COVID-19, bringing new insights into the inflammatory status or SARS-CoV-2 exposition determination.

Study of salt-induced changes in the Leptinito Gneiss of a column from the Mosteiro de São Bento in Rio de Janeiro, Brazil.

The object of this study can be found among the various ornamental rocks used in historic buildings in the city of Rio de Janeiro. It is a degraded Leptinito Gneiss that makes up one of the support columns of the kitchen of the Mosteiro de São Bento (Monastery of Saint Benedict) in Rio de Janeiro. The main aim of the present study is to identify the causes of the high degree of degradation of said column. Non-destructive tests were performed, and laboratory evaluation of the disintegrated fragments may help restore and conserve this column in the future. Results obtained from the tests performed on the altered column were compared to those obtained from another column in the monastery, also built in Leptinito, which is more intact and is a sound Leptinito Gneiss. The results showed that degradation of the column is caused by the crystallization of salts (halite) inside the rock, which is reducing its mechanical strength and causing an imminent risk of collapse.

Ghrelin May Inhibit Inflammatory Response and Apoptosis During Ischemia-Reperfusion Injury.

BACKGROUND: Ghrelin, a novel growth hormone-releasing peptide, has both anti-inflammatory and anti-apoptotic effects on human endothelial cells. We evaluated the protective effects of ghrelin against ischemia-reperfusion injury (IRI) in a murine heterotopic cervical heart transplantation model. METHODS: Donor hearts from C57BL/6J wild-type mice, which were kept in cold saline for 60 minutes, were heterotopically transplanted into C57BL/6J wild-type recipients. A day prior to heterotopic cervical heart transplantation, donor animals received either ghrelin (300 nmol/kg) or saline (0.3 mL) intraperitoneally. Upon reperfusion and postoperative day 1, ghrelin or saline was administered to the recipients. Donor hearts were procured on day 2. RESULTS: Ghrelin injection did not result in any adverse effects in donors or recipients. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive cells were significantly decreased in the ghrelin group (0.38% ± 0.21% vs 5.74% ± 3.68%; P < .001). Both cleaved caspase-3 activity and Bcl-2/Bax ratio from the ghrelin group were significantly reduced compared to those in the control. Furthermore, the phosphorylated Akt/Akt ratio was higher in the ghrelin group (0.44 ± 0.21 vs 0.14 ± 0.03; P = .043). Nuclear factor-kappa B p65 nuclear translocation was reduced in the ghrelin hearts compared to the controls (3.17% ± 1.84% vs 19.28% ± 13.14%; P = .009). Vascular cell adhesion molecule-1, intracellular adhesion molecule-1, nuclear factor-kappa B, and tumor necrosis factor alpha levels were also significantly reduced in the ghrelin-treated group. No significant difference was observed in 8-isoprostane production between groups. CONCLUSION: Ghrelin inhibits the inflammatory response and apoptosis during transplant-related IRI. This study demonstrates the protective effects of ghrelin against IRI.

Left ventricular assist device implantation via lateral thoracotomy: A systematic review and meta-analysis.

BACKGROUND: Left ventricular assist device (LVAD) implantation via lateral thoracotomy can offer similar effectiveness to conventional approaches with less perioperative adverse events. We performed a systematic review and meta-analysis to determine the potential benefits of lateral thoracotomy (LT) for LVAD implantation compared to median sternotomy. METHODS: We searched MEDLINE and Embase databases for studies comparing continuous-flow LVAD implantation using LT with conventional sternotomy. Main outcomes were perioperative mortality and complications. RESULTS: Twenty-five observational studies enrolling 3072 patients were included with a median follow-up of 10 months. Perioperative mortality (30 day or in-hospital) was 7% (LT) and 14% (sternotomy); however, mortality differences were no longer statistically significant in matched/adjusted studies (RR:0.86; 95%CI:0.52-1.44; p = 0.58). LT was associated with decreased need for blood product transfusions (mean difference[MD]: -4.7; 95%CI: -7.2 to -2.3 units; p < 0.001), reoperation for bleeding (RR:0.34; 95%CI:0.22-0.54; p < 0.001), postoperative RVAD implantation (RR:0.53; 95%CI:0.36-0.77; p < 0.001), days requiring inotropes (MD: -1.1; 95%CI: -2.1 to -0.03 inotrope days; p = 0.04), ICU (MD: -3.3; 95%CI: -6.0 to -0.7 ICU days; p = 0.01), and hospital length of stay (MD: -5.1; 95%CI: -10.1 to -0.1 hospital days; p = 0.04) in matched/adjusted studies. Overall mortality during follow-up was significantly lower for LT in unmatched/unadjusted studies but not statistically significantly lower in matched/adjusted studies (Hazard Ratio:0.82; 95%CI:0.59-1.14; p = 0.24). CONCLUSION: LVAD implantation via LT was associated with significantly decreased need for blood products, reoperation for bleeding, and postoperative RVAD implantation. Furthermore, days on inotropic support were also lower, likely contributing to the shorter length of stay. These findings support greater use of a LT approach for carefully selected patients.

Dynamic Metabolic Changes During Prolonged Ex Situ Heart Perfusion Are Associated With Myocardial Functional Decline.

Ex situ heart perfusion (ESHP) was developed to preserve and evaluate donated hearts in a perfused beating state. However, myocardial function declines during ESHP, which limits the duration of perfusion and the potential to expand the donor pool. In this research, we combine a novel, minimally-invasive sampling approach with comparative global metabolite profiling to evaluate changes in the metabolomic patterns associated with declines in myocardial function during ESHP. Biocompatible solid-phase microextraction (SPME) microprobes serving as chemical biopsy were used to sample heart tissue and perfusate in a translational porcine ESHP model and a small cohort of clinical cases. In addition, six core-needle biopsies of the left ventricular wall were collected to compare the performance of our SPME sampling method against that of traditional tissue-collection. Our state-of-the-art metabolomics platform allowed us to identify a large number of significantly altered metabolites and lipid species that presented comparable profile of alterations to conventional biopsies. However, significant discrepancies in the pool of identified analytes using two sampling methods (SPME vs. biopsy) were also identified concerning mainly compounds susceptible to dynamic biotransformation and most likely being a result of low-invasive nature of SPME. Overall, our results revealed striking metabolic alterations during prolonged 8h-ESHP associated with uncontrolled inflammation not counterbalanced by resolution, endothelial injury, accelerated mitochondrial oxidative stress, the disruption of mitochondrial bioenergetics, and the accumulation of harmful lipid species. In conclusion, the combination of perfusion parameters and metabolomics can uncover various mechanisms of organ injury and recovery, which can help differentiate between donor hearts that are transplantable from those that should be discarded.

Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial.

BACKGROUND: Robotic surgery is a valid option for minimally invasive surgery in most surgical specialties. However, the need to master laparoscopy is questionable before starting specific training in robotic surgery. We compared the development of basic robotic surgery skills between individuals randomized to train in conventional, laparoscopic, or robotic skills. METHODS: We conducted a single-centered, single-blinded randomized trial. Medical students were randomly assigned to 20 h of conventional, laparoscopic, or robotic surgical training. Students with previous surgical experience were excluded. Participants were evaluated pre- and post-training on the dV-Trainer robotic surgical simulator with the following exercises: Camera Targeting 1, Peg Board 1, Ring and Rail 1, and Ring and Rail 2. RESULTS: Sixty-six students were randomly assigned to each training group. Eight individuals did not complete the study (2 in the conventional group, 3 in the laparoscopic group, and 3 in the robotic group). All groups demonstrated significant improvement in the composite score and in each task following the training period (p < 0.001). No differences were seen between the conventional and laparoscopic groups in the composite score or individual tasks. The robotic group showed greater improvement in number of errors, economy of motion, workspace utilization, and time for completion compared to the other groups. The laparoscopic group showed improved camera manipulation skills compared to the conventional group, while the conventional group showed improved errors and economy of motion compared to the laparoscopic group. CONCLUSION: There was no difference in the acquisition of basic robotic surgical skills between individuals trained in basic conventional or laparoscopic surgical skills. We believe surgeons mastery in laparoscopy is not needed before initiating robotic surgical training. However, basic principles of laparoscopy remain applicable to robotic surgery. Future studies should compare transferability of conventional and laparoscopic training to robotic skills in the operating room.

Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment.

The increase in demand for cardiac transplantation throughout the years has fueled interest in donation after circulatory death (DCD) to expand the organ donor pool. However, the DCD process is associated with the risk of cardiac tissue injury due to the inevitable period of warm ischemia. Normothermic regional perfusion (NRP) allows for an in situ organ assessment, allowing the procurement of hearts determined to be viable. Here, we describe a clinically relevant large-animal model of DCD followed by NRP. Circulatory death is established in anesthetized pigs by stopping mechanical ventilation. After a preset warm ischemia period, an extracorporeal membrane oxygenator (ECMO) is used for a NRP period lasting at least 30 min. During this reperfusion period, the model allows the collection of various myocardial biopsies and blood samples for initial cardiac evaluation. Once NRP is weaned, biochemical, hemodynamic, and echocardiographic assessments of cardiac function and metabolism can be performed before organ procurement. This protocol closely simulates the clinical scenario previously described for DCD and NRP in heart transplantation and has the potential to facilitate studies aimed at decreasing ischemia-reperfusion injury and enhance cardiac functional preservation and recovery.

Novel heat shock protein 90 inhibitor improves cardiac recovery in a rodent model of donation after circulatory death.

OBJECTIVE: Organ donation after circulatory death (DCD) is a potential solution for the shortage of suitable organs for transplant. Heart transplantation using DCD donors is not frequently performed due to the potential myocardial damage following warm ischemia. Heat shock protein (HSP) 90 has recently been investigated as a novel target to reduce ischemia/reperfusion injury. The objective of this study is to evaluate an innovative HSP90 inhibitor (HSP90i) as a cardioprotective agent in a model of DCD heart. METHODS: A DCD protocol was initiated in anesthetized Lewis rats by discontinuation of ventilation and confirmation of circulatory death by invasive monitoring. Following 15 minutes of warm ischemia, cardioplegia was perfused for 5 minutes at physiological pressure. DCD hearts were mounted on a Langendorff ex vivo heart perfusion system for reconditioning and functional assessment (60 minutes). HSP90i (0.01 µmol/L) or vehicle was perfused in the cardioplegia and during the first 10 minutes of ex vivo heart perfusion reperfusion. Following assessment, pro-survival pathway signaling was evaluated by western blot or polymerase chain reaction. RESULTS: Treatment with HSP90i preserved left ventricular contractility (maximum + dP/dt, 2385 ± 249 vs 1745 ± 150 mm Hg/s), relaxation (minimum -dP/dt, -1437 ± 97 vs 1125 ± 85 mm Hg/s), and developed pressure (60.7 ± 5.6 vs 43.9 ± 4.0 mm Hg), when compared with control DCD hearts (All P = .001). Treatment abrogates ischemic injury as demonstrated by a significant reduction of infarct size (2,3,5-triphenyl-tetrazolium chloride staining) of 7 ± 3% versus 19 ± 4% (P = .03), troponin T release, and mRNA expression of Bax/Bcl-2 (P < .05). CONCLUSIONS: The cardioprotective effects of HSP90i when used following circulatory death might improve transplant organ availability by expanding the use of DCD hearts.

Do Fetal Microchimeric Cells Influence Experimental Autoimmune Myocarditis?

Objective: We investigated the presence and influence of fetal microchimerism in the cardiac tissue of mated female mice submitted to experimental autoimmune myocarditis. Materials and methods: Nulliparous BALB/c females and BALB/c females mated with either BALB/c males (syngeneic mating) or C57BL/6 males (allogeneic mating) were immunized with cardiac myosin peptide MyHC-α614-629 or kept as non-immunized controls. Immunization occurred 6-8 weeks after delivery and mice were assessed after 21 days. Results: Immunized mice of allogeneic mating had a lower production of anti-MyHC-α614-629 antibodies compared to immunized nulliparous mice. Immunized nulliparous females had an intense mononuclear inflammatory infiltrate in cardiac tissue, associated with fibroplasia, while mated females had a lower inflammatory reaction. An increase in the frequency of microchimeric fetal cells was observed in mice submitted to allogeneic mating following immunization. Conclusion: Allogeneic cells of fetal origin could contribute to mitigating the inflammatory response in experimental myocarditis.

Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review.

PURPOSE OF REVIEW: New evidence suggests a greater prevalence of protracted postoperative atrial fibrillation (POAF) than previously recognized. The left atrial appendage (LAA) is the most common source of embolism in patients with nonvalvular atrial fibrillation. In this review, we ask whether there is evidence to support routine LAA occlusion (LAAO) in patients without preexisting atrial fibrillation undergoing cardiac surgery. RECENT FINDINGS: Overall, available studies are small, inconsistent and have varying proportions of patients with and without preexisting atrial fibrillation. There is considerable discrepancy with respect to the efficacy of LAAO in reducing the risk of POAF-related stroke. Only one study reported a lower rate of stroke in the LAAO group compared with no LAAO. Two studies included a subgroup analysis of patients that developed POAF and report a significantly higher rate of stroke in patients that developed POAF and did not undergo LAAO. There are three clinical trials ongoing that are investigating prophylactic LAAO in patients undergoing cardiac surgery: ATLAS, LAA-CLOSURE and LAACS-2. SUMMARY: There is currently insufficient evidence to recommend routine addition of LAAO to lower the risk of postoperative stroke. Ongoing clinical trials will provide important insight into the role of routine LAAO in all patients undergoing cardiac surgery.

Distributed Architecture for Unmanned Vehicle Services.

The demand for online services is increasing. Services that would require a long time to understand, use and master are becoming as transparent as possible to the users, that tend to focus only on the final goals. Combined with the advantages of the unmanned vehicles (UV), from the unmanned factor to the reduced size and costs, we found an opportunity to bring to users a wide variety of services supported by UV, through the Internet of Unmanned Vehicles (IoUV). Current solutions were analyzed and we discussed scalability and genericity as the principal concerns. Then, we proposed a solution that combines several services and UVs, available from anywhere at any time, from a cloud platform. The solution considers a cloud distributed architecture, composed by users, services, vehicles and a platform, interconnected through the Internet. Each vehicle provides to the platform an abstract and generic interface for the essential commands. Therefore, this modular design makes easier the creation of new services and the reuse of the different vehicles. To confirm the feasibility of the solution we implemented a prototype considering a cloud-hosted platform and the integration of custom-built small-sized cars, a custom-built quadcopter, and a commercial Vertical Take-Off and Landing (VTOL) aircraft. To validate the prototype and the vehicles' remote control, we created several services accessible via a web browser and controlled through a computer keyboard. We tested the solution in a local network, remote networks and mobile networks (i.e., 3G and Long-Term Evolution (LTE)) and proved the benefits of decentralizing the communications into multiple point-to-point links for the remote control. Consequently, the solution can provide scalable UV-based services, with low technical effort, for anyone at anytime and anywhere.

Web AR Solution for UAV Pilot Training and Usability Testing.

Data and services are available anywhere at any time thanks to the Internet and mobile devices. Nowadays, there are new ways of representing data through trendy technologies such as augmented reality (AR), which extends our perception of reality through the addition of a virtual layer on top of real-time images. The great potential of unmanned aerial vehicles (UAVs) for carrying out routine and professional tasks has encouraged their use in the creation of several services, such as package delivery or industrial maintenance. Unfortunately, drone piloting is difficult to learn and requires specific training. Since regular training is performed with virtual simulations, we decided to propose a multiplatform cloud-hosted solution based in Web AR for drone training and usability testing. This solution defines a configurable trajectory through virtual elements represented over barcode markers placed on a real environment. The main goal is to provide an inclusive and accessible training solution which could be used by anyone who wants to learn how to pilot or test research related to UAV control. For this paper, we reviewed drones, AR, and human-drone interaction (HDI) to propose an architecture and implement a prototype, which was built using a Raspberry Pi 3, a camera, and barcode markers. The validation was conducted using several test scenarios. The results show that a real-time AR experience for drone pilot training and usability testing is achievable through web technologies. Some of the advantages of this approach, compared to traditional methods, are its high availability by using the web and other ubiquitous devices; the minimization of technophobia related to crashes; and the development of cost-effective alternatives to train pilots and make the testing phase easier for drone researchers and developers through trendy technologies.

Integration of functional assay data results provides strong evidence for classification of hundreds of BRCA1 variants of uncertain significance.

PURPOSE: BRCA1 pathogenic variant heterozygotes are at a substantially increased risk for breast and ovarian cancer. The widespread uptake of testing has led to a significant increase in the detection of missense variants in BRCA1, the vast majority of which are variants of uncertain clinical significance (VUS), posing a challenge to genetic counseling. Here, we harness a wealth of functional data for thousands of variants to aid in variant classification. METHODS: We have collected, curated, and harmonized functional data for 2701 missense variants representing 24.5% of possible missense variants in BRCA1. Results were harmonized across studies by converting data into binary categorical variables (functional impact versus no functional impact). Using a panel of reference variants we identified a subset of assays with high sensitivity and specificity (≥80%) and apply the American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) variant interpretation guidelines to assign evidence criteria for classification. RESULTS: Integration of data from validated assays provided ACMG/AMP evidence criteria in favor of pathogenicity for 297 variants or against pathogenicity for 2058 representing 96.2% of current VUS functionally assessed. We also explore discordant results and identify limitations in the approach. CONCLUSION: High quality functional data are available for BRCA1 missense variants and provide evidence for classification of 2355 VUS according to their pathogenicity.

Echocardiographic assessment of left ventricular function in ex situ heart perfusion using pump-supported and passive afterload working mode: a pilot study.

Ex situ heart perfusion (ESHP) has been developed to decrease cold ischemia time and allow metabolic assessment of donor hearts prior to transplantation. Current clinical ESHP systems preserve the heart in an unloaded condition and only evaluate the cardiac metabolic profile. In this pilot study we performed echocardiographic functional assessment using two alternative systems for left ventricular (LV) loading: pump supported afterload working mode (SAM) and passive afterload working modes (PAM). Six hearts were procured from male Yorkshire pigs. During cold ischemia, hearts were mounted on our custom made ESHP circuit and a 3D-printed enclosure for the performance of echocardiography with a standard TEE probe. Following perfusion with Langherdorf mode of the unloaded heart, the system was switched into different working modes to allow LV loading and functional assessment: pump supported (SAM) and passive (PAM). Echocardiographic assessment of left ventricular function in the donor hearts was performed in vivo and at 1 h of ESHP with SAM, after 4.5 h with PAM and after 5.5 h with SAM. We obtained good quality epicardial echocardiographic images at all time points allowing a comprehensive LV systolic assessment. All indices showed a decrease in LV systolic function throughout the trial with the biggest drop after heart harvesting. We demonstrated the feasibility of echocardiographic functional assessment during ESHP and two different working modes. The expected LV systolic dysfunction consisted of a reduction in EF, FAC, FS, and strain throughout the experiment with the most significant decrease after harvesting.

Platelet Transfusion in Cardiac Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND: Blood transfusion is a well-established independent risk factor for mortality in patients undergoing cardiac surgery but the impact of platelet transfusion is less clear. We performed a systematic review and meta-analysis of observational studies comparing outcomes of patients who received platelet transfusion after cardiac surgery. METHODS: We searched MEDLINE and EMBASE databases to January 2019 for studies comparing perioperative outcomes in patients undergoing cardiac surgery with and without platelet transfusion. RESULTS: There were nine observational studies reporting 101,511 patients: 12% with and 88% without platelet transfusion. In unmatched/unadjusted studies, patients who received platelet transfusion were older, with greater incidence of renal, peripheral, and cerebrovascular disease, myocardial infarction, left ventricular dysfunction, and anemia. They were more likely to have nonelective, combined surgery; preoperative hemodynamic instability and endocarditis; and more likely to be receiving clopidogrel preoperatively. Perioperative complications were significantly increased without adjusting for these baseline differences. After pooling only matched/adjusted data, differences were not found between patients who did receive platelets and patients who did not in operative mortality (risk ratio [RR] 1.26; 95% confidence interval [CI], 0.69 to 2.32, P = .46, five studies), stroke (RR 0.94; 95% CI, 0.62 to 1.45; P = .79; five studies), myocardial infarction (RR 1.29; 95% CI, 0.95 to 1.77; P = .11; three studies), reoperation for bleeding (RR 1.20; 95% CI, 0.46 to 3.18; P = .71; three studies), infection (RR 1.02; 95% CI, 0.86 to 1.20; P = .85; six studies); and perioperative dialysis (RR 0.91; 95% CI, 0.63 to 1.32; P = .62; three studies). CONCLUSIONS: After accounting for baseline differences, platelet transfusion was not linked with perioperative complications in cardiac surgery patients. Given the small number of observational studies, these findings should be considered hypothesis generating.