Arterial versus end-tidal carbon dioxide levels in children with congenital heart disease: a prospective cohort study in patients undergoing pulmonary catheterization.

Capnography has been the standard in the operating room for a long time now. When variable amounts of intrapulmonary shunt and intracardiac shunt are taken into account, arterial carbon dioxide (CO2) and end-tidal CO2 typically match rather well. The gap between arterial and end-tidal CO2 widens in patients with cardiopulmonary disorders. The current study sought to determine how arterial and end-tidal CO2 correlated with each other and with hemoglobin saturation both before and after pulmonary catheterization in a pediatric population with congenital heart disease. Methods: Fifty-seven children with congenital heart disease who underwent cardiopulmonary catheterization between March 2018 and April 2019 were included in a prospective cohort study at Children's Medical Center. Arterial and end-tidal CO2, and hemodynamic variables were assessed prior to the catheterization procedure. Then the patients underwent catheterization, and before being extubated, these variables were again assessed and compared to the baseline levels. Results: End-tidal CO2 increased significantly in cyanotic patients following the catheterization procedure, and the difference between arterial and end-tidal CO2 decreased significantly. End-tidal CO2, arterial CO2, and their difference did not significantly change in non-cyanotic patients following the catheterization procedure. End-tidal and arterial CO2 were not significantly correlated in cyanotic patients (r=0.411, P=0.128), but they were correlated after the catheterization procedure (r=0.617, P=0.014). Conclusions: End-tidal CO2 can estimate arterial CO2 in non-cyanotic patients reasonably. End-tidal CO2 cannot be used to estimate arterial CO2 in cyanotic patients since there is no association. After cardiac defect correction, end-tidal CO2 can be a reliable predictor of arterial CO2.

Mesenchymal stem cells as professional actors in gastrointestinal cancer therapy: From Naïve to genetically modified.

Considering the high incidence and mortality rate of gastrointestinal cancers (GIs) worldwide and partial success of the current available GI cancer treatments, there is a necessity to discover more effective approaches in cancer therapy. The failure in conventional therapies seems to be related to the resistance of cancer cells to chemotherapy, inability to target tumor cells especially in metastatic cancers, deficient drug concentrations in tumor sites, and unfavorable effects on pivotal non-malignant bodily tissues following systemic administration. In this context, we need an appropriate carrier for the delivery of therapeutic agents specifically to the GI cancer site. Mesenchymal stem cells (MSCs), a prominent cell-based strategy for cancer treatment, overcome various cancer therapy limitations and could be used as vehicles to deliver many anticancer agents such as therapeutic genes (DNA or interference RNA), oncolytic viruses, and chemotherapeutic or nanoparticle drugs. Moreover, secreted molecules of unmodified MSCs lead to deregulation of several proteins and different signaling pathways eradicating cancer cells. In the present review, at first, we overview the characteristics and utility of MSCs in cancer therapy, secondly, we discuss the application of naïve MSCs and utilization of MSCs in the delivery of therapeutic agents in GI cancer therapy and, finally, more information about harnessing of genetically modified MSCs in GI cancer treatment will be presented.