Custodiol HTK cardioplegia use in robotic mitral valve.

Robotic surgery is a growing subspecialty in cardiac surgery. Custodiol HTK cardioplegia offers long-term myocardial protection, decreased metabolism, and eliminates multiple cardioplegia dosing. This article reviews the technique, strategy, and considerations for use of Custodiol HTK for myocardial protection in robotic mitral valve surgery.

An in-vitro comparison between Hemobag and non-Hemobag ultrafiltration methods of salvaging circuit blood following cardiopulmonary bypass.

Ultrafiltration of the residual cardiopulmonary bypass circuit blood has become one of the most advantageous procedures to maximize autologous whole blood recovery and coagulation management in cardiovascular surgery. In this in-vitro study, the Hemobag technique (HB) was compared to the most common non-Hemobag method (NHB) of hemoconcentrating residual circuit blood. The residual bovine blood from 10 identical extracorporeal circuits was processed by the recirculating HB technique or by a venous reservoir NHB concentration method. Blood component concentrations and hemolysis levels were measured before and after processing. The HB method yielded significantly higher hemoglobin, hematocrit, fibrinogen, albumin, and total protein levels in the final product. There was no significant difference in final product platelet and white blood cell counts, or hemolysis index. HB processing times were substantially shorter at all residual circuit volumes tested. The HB technique resulted in significantly less wasted red blood cells at the end of processing. The recirculating HB method to process residual extracorporeal circuit blood is consistent and superior to the most common single pass concentrating method.

Extracorporeal life support for pandemic influenza: the role of extracorporeal membrane oxygenation in pandemic management.

The recent global threat of a severe pandemic influenza outbreak has suggested that extracorporeal life support will begin to play an evolving role in the care of critically ill influenza stricken patients. The highly communicable attributes of influenza could result in widespread infection and an associated increased need for advanced life support. Supply and demand equilibrium may be abruptly disrupted, and ethical decisions regarding the allocation of life saving resources will inevitably need to be made. Protocol oriented planning, research analysis, and advanced technologies are critical factors in averting catastrophe. This review article details the epidemiology, diagnostic techniques, and interventions for the influenza A virus, including H1N1.

Development and validation of an automated static headspace gas chromatography-mass spectrometry (SHS-GC-MS) method for monitoring the formation of ethyl methane sulfonate from ethanol and methane sulfonic acid.

An automated sample preparation and analysis procedure was developed to monitor the formation of ethyl methane sulfonate from reaction mixtures containing ethanol and methane sulfonic acid. The system is based on a liquid handling robot combined with a static headspace module. The formed ethyl methane sulfonate is analysed after derivatisation with pentafluorothiophenol using static headspace-gas chromatography-mass spectrometry (SHS-GC-MS). Using the automated reaction-derivatisation-headspace GC-MS system, the formation of ethyl methane sulfonate can be monitored in different reaction mixtures under different reaction conditions, including temperature, water content and pH. Excellent linearity, repeatability and robustness were obtained, allowing the system to be used in kinetic studies.

The utility of sulfonate salts in drug development.

The issue of controlling genotoxic impurities in novel active pharmaceutical ingredients (APIs) is a significant challenge. Much of the current regulatory concern, has been focused on the formation and control of genotoxic sulfonate esters. This is linked with the withdrawal of Viracept (Nefinavir mesilate) from European markets in mid-2007, over concerns about elevated levels of ethyl methanesulfonate (EMS). This issue has resulted in calls from European regulators to assess risk mitigation strategies for all marketed products employing a sulfonic acid counter-ion to ensure that the sulfonate esters that could be potentially formed are controlled to threshold of toxicological concern (TTC)-based limits. This has even led to calls to avoid sulfonic acids as salt counter-ions. However, sulfonic acid salts possess a range of properties that are useful to both synthetic and formulation chemists. Whilst sulfonate salts are not a universal panacea to some of the problems of salt formation they do offer significant advantages as alternatives to other salt forming moieties under certain circumstances. This review thus sets out to define some of the advantages provided through utilization of sulfonic acids, explaining the importance of their retention as part of a thorough salt selection process.