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Adverse Drug Effect Report regarding Anticancer Agents inside a Tertiary Proper care Hospital: The Observational Review.
OBJECTIVES To describe international practices on the use of calcium salts during cardiopulmonary bypass (CPB) weaning in adult cardiac surgery patients. DESIGN Multiple-choice survey on current practice of CPB weaning. SETTING Online survey using the SurveyMonkey platform. PARTICIPANTS Departments of cardiac anesthesiology worldwide. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Out of 112 surveys sent, 100 centers from 32 countries replied. The majority of centers (88 of 100 = 88%) administer calcium salts intraoperatively 71 of 100 (71%) are using these drugs for CPB weaning and 78 of 100 (78%) for correction of hypocalcemia. Among the 88 centers that use calcium salts intraoperatively, 66% (58 of 88) of respondents use calcium chloride, 22% (19 of 88) use calcium gluconate, and 12% (11 of 88) use both drugs. Calcium salts are routinely used during normal (47 of 71 centers = 66%) and difficult (59 of 71 centers = 83%) weaning from CPB. Doses of 5 to 15 mg/kg during termination of CPB were used by 55 of 71 centers (77%) either by bolus (39 of 71, 55%) or over a time period longer than 1 minute (32 of 71 = 45%). Norepinephrine is the most commonly used first line vasopressor or inotropic agent used to support hemodynamics during termination of CPB in 32 out of 100 centers (32%), and calcium is the second one, used by 23 out of 100 centers (23%). CONCLUSION This survey demonstrates that the majority of cardiac centers use calcium in adult patients undergoing cardiac surgery, especially during weaning from CPB. There is variability on the type of drug, dose, and modality of drug administration. Liver transplantation continues be the standard for treatment of end-stage liver disease, and even with recent advances in organ preservation, the anesthetic management continues to require understanding of multiple organ systems beyond the liver. TBOPP mouse Multiple factors contribute to hemodynamic changes after reperfusion of the liver graft that anesthesiologists should be aware of before unclamping. Concomitant renal dysfunction in end-stage liver disease is not uncommon, and preparation for continuous renal replacement therapy may need to be considered in certain cases. Cardiac evaluation of liver transplantation patients with an emphasis on arrhythmias, including atrial fibrillation, can help prevent both intraoperative and postoperative complications detrimental to the patient and graft. Finally, combined liver and thoracic organ transplantations may be indicated for certain disease processes that affect multiple organs. These cases require an understanding of the surgical technique and acknowledgment that some goals of the procedures may be in direct opposition to each other. OBJECTIVE Lifetime intellectual engagement may be associated with cognitive ability late in life. However, the current evidence on whether cognitive activities will improve and/or maintain cognitive function is heterogeneous. Drawing on knowledge of the brain's intrinsic small-world organization which combines regional specialization and efficient global information transfer, we aimed to explore that whether individual differences in the small-worldness of resting-state functional connectivity (rsFC) networks would explain the variability in the strength of the association between intellectual engagement and cognitive functioning. METHODS Sixty-five elderly people without dementia were enrolled and scanned with a 52-channel near-infrared spectroscopy system. The number, frequency, and participation hours of intellectual activities were investigated to measure intellectual engagement. Global cognition was assessed by the Montreal Cognitive Assessment. The general linear models and the simple slope analysis were employed to measure the modulatory role of network properties. RESULTS The small-worldness of the brain network emerged as a moderator of the association between intellectual engagement and cognition. Exclusively among elderly people with lower small-worldness, greater intellectual engagement, including the frequency and participation hours of activities, was associated with greater global cognitive function. Furthermore, we observed that elderly people with lower small-worldness exhibited decreased rsFC across the bilateral frontopolar areas and increased rsFC across the bilateral parietal cortex. CONCLUSION The individual differences in the small-worldness of rsFC networks might explain the varying strength of the association between intellectual engagement and cognitive functioning. Our findings imply that the intrinsic small-worldness of the brain network might be a potential neurobiological contributor that interacts with the intellectual engagement in enhancing the cognitive ability in late life. BACKGROUND Left ventricular (LV) assist devices (LVADs) are known to elicit reverse remodeling by mechanically unloading the left ventricle. Current guidelines target a reduction in LV end-diastolic diameter (LVEDD) of 15% compared with pre-LVAD dimensions; however, there is significant heterogeneity in the degree of unloading achieved. We sought to investigate factors associated with mechanical unloading at 6 months of LVAD support. METHODS Data were retrospectively collected for 75 LVAD recipients at five time points pre-LVAD, within 14 days post-LVAD, and at 1, 3, and 6 months post-LVAD. The percentage change in LVEDD between the pre-LVAD and 6 months post-LVAD time points was termed ΔLVEDD. Optimal LV unloading was defined as ΔLVEDD of ≥15% at 6 months. Patients who achieved optimal unloading (group A, n = 30) were compared with patients who did not (group B, n = 45). RESULTS At 6 months, optimally unloaded patients (group A) demonstrated higher fractional shortening (15% ± 10% vs 10% ± 7%, P = .007), lower rates of moderate or severe mitral regurgitation (10% vs 33%, P = .02), and lower pulmonary capillary wedge pressure (9 ± 4 vs 16 ± 7 mm Hg, P = .02). Right ventricular dysfunction was more prevalent at 6 months in poorly unloaded (group B) patients (73% vs 43%, P = .008). Between hospital discharge and 6 months, the percentage increase in pump speed (Δ revolutions per minute) was higher in group A patients (4.4% ± 3.7% vs 0.1% ± 2.6%, P less then .001). In a multivariate analysis, Δ revolutions per minute and tricuspid annular systolic velocity (S') at 6 months were independently associated with 6-month ΔLVEDD. CONCLUSIONS Recipients of LVADs who undergo progressive pump speed up-titration during outpatient follow-up are more likely to sustain optimal LV unloading. Progressive LVAD-related right ventricular failure is prevalent in suboptimally unloaded patients.
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