Factors affecting extubating time of postoperative patients who underwent congenital cardiac surgery: a randomized prospective study.

OBJECTIVE: Anesthesia management in pediatric cardiac surgery using health resources sparingly focuses on reducing morbidity and mortality and increasing patients' quality of life. The duration of postoperative mechanical ventilation (MV) heavily influences pediatric cardiac surgery recovery. Thus, in this study we aimed to determine factors influencing extubation times after pediatric cardiac surgery. PATIENTS AND METHODS: A total of 72 pediatric patients with an ASA score of III or above undergoing cardiac surgery were included in the study. As a result of their extubation time, the patients were divided into three groups as follows: those who were extubated immediately after surgery or in the operating room (OR) were recorded as Immediate Extubators (IE); those who were extubated within 6 to 48 hours of entering the intensive care unit were recorded as Early Extubators (EE), and those who were extubated after 48 hours or not extubated were recorded as Delayed Extubators (DE). RESULTS: A logistic regression analysis showed that anomalies and need of MV before surgery, airway difficulty, and prolonged cross-clamp (CC) time were observed as factors affecting DE. The risk of DE was significantly correlated with the presence of abnormality [Odds ratio (OR): 20.3, 95% Confident interval (CI): 2.8-142.7], with the need of MV before surgery (OR: 1,844, 95% CI: 1.8-1,790,461.9), and with the presence of airway difficulty (OR: 44.7, 95% CI: 4.4-445.0). In addition, it was determined that CC time increased the probability of DE 1.038 times per minute (95% CI: 1.004-1.072). CONCLUSIONS: Early and immediate extubation in children who underwent congenital heart surgery was successfully performed in our clinic. Early and immediate extubation in pediatric cardiac surgery can be completed safely and successfully when suitable conditions are provided.

Altering apparent optical properties with an array of semitransparent mesoscale structures.

The ability to control and optimize interactions between light and matter has much utility in engineering design. A well-researched way to achieve optical property modulation is via the use of optical metamaterials, which feature sub-wavelength scale surface structures. In this work, an alternative approach for modulating optical properties is presented using a composite surface modified with a periodic array of semitransparent hemispherical shell mesoscale structures which are larger than the incident light wavelength. A ray-tracing simulation approach is used to predict the optical behavior for an arrayed surface. At oblique angles of incidence, significant increases and decreases in apparent absorptance are achieved via the use of optically thick and thin shells, respectively. Additionally, a potential application to solar cells is described with optimal spectral behavior achieved via the use of semitransparent external structures.

Futility Versus Acceptability of the Use of Grafts Taken From End of Line in the National Organ-Sharing Network.

BACKGROUND: The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution. METHODS: The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed. RESULTS: A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively. CONCLUSIONS: The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.

Liver Transplantation With Livers From Octogenarians and a Nonagenarian.

INTRODUCTION: A shortage of deceased donors has compelled the use of extended-criteria donor organs in liver transplantation. The purpose of this study was to evaluate the impact of using deceased donors older than 80 years. MATERIALS AND METHODS: We retrospectively evaluated 13 patients who received a liver graft from cadaveric donors older than 80 years between December 2007 and March 2014. We analyzed the donor and their recipient characteristics together with morbidity and mortality of recipients. RESULTS: All 13 donors were older than 80 years (median age, 82.7; range, 80-93). There were 9 male and 4 female recipients with an average age of 50.7 (range, 2-65) years. All of the recipients did not have a living donor for liver transplantation. Recipients' mean model for end-stage liver disease (MELD) score was 14.2 (range, 7-20). Graft with macroscopic steatosis was not accepted. Medium follow-up was 19.5 months. The most frequent cause for liver transplantation (LT) was hepatitis B virus (HBV) cirrhosis (8/13 patients). We had 1 case of primary nonfunction, and 4 patients died in 2 weeks after surgery. Of these patients, 2 of them received a split transplant from an 80-year-old cadaver liver. Overall the survival rate after 1 year was 61.5%. CONCLUSIONS: Deceased elderly donor usage in LT could expand the donor pool. Liver grafts from donors older than 80 years can be used in necessity or emergency situations. However, care should be taken to avoid early mortality and primary nonfunction. Procedures extending cold ischemia time such as split liver transplantation may increase the risk of primary nonfunction.

Cytokine-mediated enhancement of epidermal growth factor receptor expression provides an immunological approach to the therapy of pancreatic cancer.

The increased expression of epidermal growth factor receptor induced by tumor necrosis factor alpha renders pancreatic cancer cells more susceptible to antibody-dependent cellular cytotoxicity by a mAb specific for this receptor. Laboratory studies with athymic mice bearing xenografts of human pancreatic cancer cells demonstrated a cytokine-induced ability of the mAb to cause significant tumor regression. In a phase I/II clinical trial, 26 patients with unresectable pancreatic cancer were enrolled into three cohorts receiving variable amounts of the antibody together with a constant amount of tumor necrosis factor alpha. With increasing doses of antibody, the growth of the primary tumor was significantly inhibited. This was reflected by a longer median survival, with one complete remission lasting for 3 years obtained with the highest dose of antibody employed. Thus, a combination of the cytokine, tumor necrosis factor alpha, with a mAb to the epidermal growth factor receptor offers a potentially useful approach for the treatment of pancreatic cancer.

Demonstration of frontal hypoperfusion in benign exertional headache by Technetium-99m-HMPAO SPECT.

We present a case of benign exertional headache (BEH) in a 15-yr-old boy. The patient suffered from exclusively exercise-induced headaches with migraine-like accompanying symptoms. No pathology could be detected by routine cardiovascular or neurological examinations by CT. The postexercise 99mTc-HMPAO brain SPECT performed during the provoked headache attack showed asymmetric bifrontal hypoperfusion. A second 99mTc-HMPAO study during a symptom-free phase under resting conditions was normal. The detection of impaired regional cerebral blood flow (rCBF) by 99mTc-HMPAO brain SPECT indicates a perfusion-related pathology in this type of headache. Analysis of rCBF with 99mTc-HMPAO in larger studies could be helpful in the clarification of BEH pathogenesis.