COMMENCE trial (Comparing hypOtherMic teMperaturEs duriNg hemiarCh surgEry): a randomized controlled trial of mild vs moderate hypothermia on patient outcomes in aortic hemiarch surgery with anterograde cerebral perfusion

This study proposes a multi-center RCT in order to compare outcomes of warmer hypothermic strategies during aortic hemiarch surgery on a composite endpoint of neurologic and acute kidney injury (AKI).Methods/designThis is a prospective multi-center, single-blind two-arm RCT comparing mild (32  °C) versus moderate (26 °C) hypothermic cardiac arrest in patients (n = 282) undergoing hemiarch surgery with antegrade cerebral perfusion (ACP). The primary endpoint is a composite of neurological injury (incidence of transient ischemic attack and/or stroke) and Kidney Disease Improving Global Outcomes (KDIGO) stage 1 or higher AKI. Secondary outcomes include de ath, cardiopulmonary bypass time, bleeding, transfusion rates, prolonged mechanical ventilation, myocardial infarction, length of stay, and quality of life measures.Patients will undergo 1:1 block randomization to each treatment arm on day of surgery. Sequence of operation will be at the surgeon ’s discretion with mandatory guidelines for temperature and ACP administration. Perioperative management will occur as per enrolling center standard of care. Neurocognitive function will be assessed for neurological injury using validated neurological screening tests: NIHSS, MOCA, BI, and MRS thro ughout patient follow-up. Diagnosis and classification of AKI will be based on rising creatinine values as per the KDIGO criteria. Study duration for each patient will be 60 ± 14&t...
Source: Trials - Category: Research Source Type: clinical trials

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ConclusionsThese results demonstrate that a novel proton-coupled organic cation antiporter plays a predominant role in the blood to brain influx of AC, MA and HA at the BBB, and thus affect the safety of Aconitum species.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
This study investigated the cardioprotective effect of vitexin against MIRI and its possible mechanism. Isolated SD rat hearts were subjected to MIRI in a Langendorff perfusion system, and H9c2 cells were subjected to hypoxia/reoxygenation (H/R) in vitro. Ex vivo experiments showed improved left ventricular function and reduced infarct size in the vitexin group. Transmission electron microscopy showed that I/R caused outer mitochondrial membrane rupture, cristae disappearance and vacuolation, while vitexin reduced mitochondrial damage and ultimately reduced cardiomyocyte apoptosis. In vitro, vitexin protected H9c2 cells fr...
Source: Biomedicine and Pharmacotherapy - Category: Drugs & Pharmacology Source Type: research
Source: Core Evidence - Category: Drugs & Pharmacology Tags: Core Evidence Source Type: research
Over the last decades, virtual reality (VR) emerged as a potential tool for developing new rehabilitation treatments in neurological patients. However, despite the increasing number of studies, a clear comprehension about the impact of immersive VR-treatme...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Ergonomics, Human Factors, Anthropometrics, Physiology Source Type: news
Clinical pharmacists have helped reduce the number of strokes by 22% following an atrial fibrillation pilot in Tameside and Glossop.
Source: The Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
No abstract available
Source: Biomedical Safety and Standards - Category: Medical Devices Tags: RECALLS & FIELD CORRECTIONS—CLASS II Source Type: research
Women whose periods stop before the age of 40 are at greater risk of diabetes, heart disease, strokes, asthma and breast cancer, the study found. The UK menopause average is 51.
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
AbstractThe purpose of this study is to investigate the relationship between morphology, hemodynamics, and aneurysm wall enhancement (AWE) on vessel wall MRI and their potential role in rupture of intracranial aneurysms. Fifty-seven patients (22 males and 35 females; mean age of 58.4) harboring 65 unruptured intracranial aneurysms were retrospectively recruited. Vessel wall MRI images were reviewed and differentiated as no (NAWE), partial (PAWE), and circumferential (CAWE) wall enhancement. Computational geometry and computational fluid dynamics were used to calculate morphological and hemodynamic parameters. The PHASES sc...
Source: Translational Stroke Research - Category: Neurology Source Type: research
Neurofeedback-guided motor-imagery training (NF-MIT) has been proposed as a promising intervention following upper limb motor impairment. In this intervention, paretic stroke patients receive online feedback about their brain activity while conducting a motor-imagery (MI) task with the paretic limb. Typically, the feedback provided in NF-MIT protocols is an abstract visual signal based on a fixed trial. Here we developed a self-paced NF-MIT paradigm with an embodiable feedback signal (EFS), which was designed to resemble the content of the mental act as closely as possible. To this end, the feedback was delivered via an em...
Source: Frontiers in Human Neuroscience - Category: Neuroscience Source Type: research
Conclusions[18F]DPA-714-PET imaging may facilitate the diagnosis and treatment monitoring of PACNS. Further studies are needed to fully understand the potential of TSPO-PET in deciphering the heterogeneity of the disease.
Source: European Journal of Nuclear Medicine and Molecular Imaging - Category: Nuclear Medicine Source Type: research
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