Publications by authors named "Jiapeng Huang"

96 Publications

Synthesis and dissociation of soliton molecules in parallel optical-soliton reactors.

Light Sci Appl 2021 Jun 7;10(1):120. Epub 2021 Jun 7.

Max Planck Institute for the Science of Light Staudtstrasse 2, 91058, Erlangen, Germany.

Mode-locked lasers have been widely used to explore interactions between optical solitons, including bound-soliton states that may be regarded as "photonic molecules". Conventional mode-locked lasers normally, however, host at most only a few solitons, which means that stochastic behaviours involving large numbers of solitons cannot easily be studied under controlled experimental conditions. Here we report the use of an optoacoustically mode-locked fibre laser to create hundreds of temporal traps or "reactors" in parallel, within each of which multiple solitons can be isolated and controlled both globally and individually using all-optical methods. We achieve on-demand synthesis and dissociation of soliton molecules within these reactors, in this way unfolding a novel panorama of diverse dynamics in which the statistics of multi-soliton interactions can be studied. The results are of crucial importance in understanding dynamical soliton interactions and may motivate potential applications for all-optical control of ultrafast light fields in optical resonators.
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http://dx.doi.org/10.1038/s41377-021-00558-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184919PMC
June 2021

Decrease in cerebral oxygen saturation and the increase in heart rate is a prewarning window of hypotension after spinal anesthesia for cesarean section: A pilot observational study.

J Clin Anesth 2021 Oct 1;73:110360. Epub 2021 Jun 1.

Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, PR China. Electronic address:

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http://dx.doi.org/10.1016/j.jclinane.2021.110360DOI Listing
October 2021

The Effects of Beverage Intake after Exhaustive Exercise on Organ Damage, Inflammation and Oxidative Stress in Healthy Males.

Antioxidants (Basel) 2021 May 28;10(6). Epub 2021 May 28.

Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan.

Strenuous exercise induces organ damage, inflammation and oxidative stress. To prevent exercise-induced organ damage, inflammation and oxidative stress, rehydrating may be an effective strategy. In the present study, we aimed to examine whether beverage intake after exhaustive exercise to recover from dehydration prevents such disorders. Thirteen male volunteers performed incremental cycling exercise until exhaustion. Immediately after exercise, the subjects drank an electrolyte containing water (rehydrate trial: REH) or did not drink any beverage (control trial: CON). Blood samples were collected before (Pre), immediately (Post), 1 h and 2 h after exercise. Urine samples were also collected before (Pre) and 2 h after exercise. We measured biomarkers of organ damage, inflammation and oxidative stress in blood and urine. Biomarkers of muscle, renal and intestinal damage and inflammation increased in the blood and urine after exercise. However, changes in biomarkers of organ damage and inflammation did not differ between trials ( > 0.05). The biomarker of oxidative stress, thiobarbituric acid reactive substances (TBARS), in plasma, showed different changes between trials ( = 0.027). One hour after exercise, plasma TBARS concentration in REH had a higher trend than that in CON ( = 0.052), but there were no significant differences between Pre and the other time points in each trial. These results suggest that beverage intake after exercise does not attenuate exercise-induced organ damage, inflammation or oxidative stress in healthy males. However, rehydration restores exercise-induced oxidative stress more quickly.
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http://dx.doi.org/10.3390/antiox10060866DOI Listing
May 2021

Implementing an Electronic Hand Hygiene System Improved Compliance in the Intensive Care Unit.

Am J Infect Control 2021 May 27. Epub 2021 May 27.

Department of Anesthesiology & Perioperative Medicine, School of Medicine, University of Louisville, Louisville, KY, USA; Department of Cardiovascular & Thoracic Surgery, School of Medicine, University of Louisville, Louisville, USA; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, Louisville, KY, USA; Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA. Electronic address:

Background: Hand hygiene (HH) compliance is low and difficult to improve among healthcare workers. We aim to validate an electronic HH system and assess the impact of this system on HH compliance and quality changes over time at both group and individual levels.

Methods: An automated electronic hand hygiene system was installed in a 10-bed surgical intensive care unit.

Results: The full HH compliance rate increased significantly from 8.4% in week 1 to 20.5% in week 16 with week 10 being the highest (27.4%). The partial compliance rate maintained relative consistency between 13.2 % to 20.0 %. The combined compliance rate (full compliance rate + partial compliance rate) increased from 23.5% in week 1 to 34.6% in week 16 with week 10 being the highest (41.4%).

Discussion: We found significant variations among providers in terms of HH opportunities per shift, full compliance, partial compliance and combined compliance rates. The average duration of hand rubbing over time in partial compliance occurrences did not change significantly over time.

Conclusions: A sensor-based platform with automated HH compliance and quality monitoring, real time feedback and comprehensive individual level analysis, improved providers' HH compliance in an ICU. There were significant variations among individual providers.
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http://dx.doi.org/10.1016/j.ajic.2021.05.014DOI Listing
May 2021

A specific low-density neutrophil population correlates with hypercoagulation and disease severity in hospitalized COVID-19 patients.

JCI Insight 2021 05 10;6(9). Epub 2021 May 10.

Department of Microbiology and Immunology.

SARS coronavirus 2 (SARS-CoV-2) is a novel viral pathogen that causes a clinical disease called coronavirus disease 2019 (COVID-19). Although most COVID-19 cases are asymptomatic or involve mild upper respiratory tract symptoms, a significant number of patients develop severe or critical disease. Patients with severe COVID-19 commonly present with viral pneumonia that may progress to life-threatening acute respiratory distress syndrome (ARDS). Patients with COVID-19 are also predisposed to venous and arterial thromboses that are associated with a poorer prognosis. The present study identified the emergence of a low-density inflammatory neutrophil (LDN) population expressing intermediate levels of CD16 (CD16Int) in patients with COVID-19. These cells demonstrated proinflammatory gene signatures, activated platelets, spontaneously formed neutrophil extracellular traps, and enhanced phagocytic capacity and cytokine production. Strikingly, CD16Int neutrophils were also the major immune cells within the bronchoalveolar lavage fluid, exhibiting increased CXCR3 but loss of CD44 and CD38 expression. The percentage of circulating CD16Int LDNs was associated with D-dimer, ferritin, and systemic IL-6 and TNF-α levels and changed over time with altered disease status. Our data suggest that the CD16Int LDN subset contributes to COVID-19-associated coagulopathy, systemic inflammation, and ARDS. The frequency of that LDN subset in the circulation could serve as an adjunct clinical marker to monitor disease status and progression.
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http://dx.doi.org/10.1172/jci.insight.148435DOI Listing
May 2021

Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial.

J Cardiothorac Vasc Anesth 2021 Mar 27. Epub 2021 Mar 27.

Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC. Electronic address:

Objectives: The study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation.

Design: Prospective, randomized and controlled trial.

Setting: A Cantonese cardiac center in China.

Participants: Two hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018.

Interventions: Patients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system.

Measurements And Main Results: The primary outcome was the lowest oxygen saturation (SpO). Secondary outcomes included the incidence of hypoxia (SpO < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications.

Conclusion: When compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.
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http://dx.doi.org/10.1053/j.jvca.2021.03.031DOI Listing
March 2021

Clinicopathological Characteristics and Prognosis of Poorly Differentiated Thyroid Carcinoma Diagnosed According to the Turin Criteria.

Endocr Pract 2021 May 15;27(5):401-407. Epub 2020 Dec 15.

Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China. Electronic address:

Objective: Poorly differentiated thyroid carcinoma (PDTC) is the primary cause of death in patients with nonanaplastic follicular cell-derived thyroid carcinoma. We purposed to identify the clinical and pathological characteristics of PDTC and their relationship with prognosis.

Methods: A retrospective analysis was conducted on patients diagnosed with PDTC at our institution from 2010 to 2018. All of their histopathology slides were reviewed by 2 experienced pathologists based on the Turin criteria. Furthermore, information regarding clinical characteristics, pathological characteristics, treatment strategy, and follow-up events were collected. The Kaplan-Meier method was used for survival analysis, while the log-rank test was used to compare survival curves. Then, the Cox proportional hazards model was used to perform univariate and multivariate analyses.

Results: Twenty-six patients with PDTC who met the Turin criteria were enrolled in this study. The median follow-up period of the included 26 patients was 76 months, while the 3- and 5-year survival rates were 40% and 18%, respectively. Notably, univariate analysis revealed that tumor size >4 cm (P = .038), extrathyroidal extension (ETE) (P = .020), distant metastases (P = .047), poorly differentiated areas >60% (P = .049), and Ki-67 labeling index >30% (P = .040) were associated with poor prognosis. On the other hand, multivariate analysis identified ETE (P = .007) and distant metastases (P = .031) as independent risk factors for poor prognosis.

Conclusion: PDTC is a rare carcinoma with high invasiveness and poor prognosis. Patients with ETE or distant metastases may have adverse outcomes.
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http://dx.doi.org/10.1016/j.eprac.2020.11.008DOI Listing
May 2021

Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients.

J Cardiothorac Vasc Anesth 2021 Mar 8. Epub 2021 Mar 8.

Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY.

Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.
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http://dx.doi.org/10.1053/j.jvca.2021.03.007DOI Listing
March 2021

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients.

J Cardiothorac Vasc Anesth 2021 Mar 27. Epub 2021 Mar 27.

Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY; Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY. Electronic address:

Objective: To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race.

Design: Retrospective cohort analysis from March 9, 2020 to June 20, 2020.

Setting: Population-based study in Louisville, KY, USA.

Participants: Seven hundred adult inpatients hospitalized with COVID-19.

Interventions: N/A.

Measurements And Main Results: This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients.

Conclusions: Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.
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http://dx.doi.org/10.1053/j.jvca.2021.03.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997853PMC
March 2021

Perioperative Cardiac Research Considerations During the Coronavirus Disease 2019 (COVID-19) Pandemic.

J Cardiothorac Vasc Anesth 2021 06 5;35(6):1573-1577. Epub 2021 Feb 5.

Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2021.01.052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863767PMC
June 2021

Radial artery catheterisation pressure monitoring with a closed intravascular catheter system and ultrasound-guided dynamic needle tip positioning technique.

Br J Anaesth 2021 04 26;126(4):e144-e146. Epub 2021 Jan 26.

Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China. Electronic address:

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http://dx.doi.org/10.1016/j.bja.2020.12.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176644PMC
April 2021

Unilateral Tnm T1 And T2 Papillary Thyroid Carcinoma With Lateral Cervical Lymph Node Metastasis: Total Thyroidectomy or Lobectomy?

Endocr Pract 2020 Oct;26(10):1085-1092

From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China.. Electronic address:

Objective: The aim of this study was to explore the effect of total thyroidectomy (TT) and lobectomy (LT) on the prognosis of unilateral papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis.

Methods: Patients with PTC and lateral cervical lymph node metastasis who underwent lateral cervical lymph node dissection between January 2007 and December 2016 were retrospectively reviewed. To investigate the effect of surgical procedure on the prognosis of lymph node metastasis patients, other high-risk factors such as extrathyroidal invasion and large tumor size were excluded. All patients were in Tumor-Node-Metastasis (TNM) stage T1 and T2. Primary end point was recurrence-free survival (RFS).

Results: Among 264 PTC patients, 104 (39.4%) patients received TT and 160 (60.6%) patients received LT. With a median follow-up of 50 months (interquartile range, 34 to 74 months), 7 patients (2.65%) experienced recurrence. The 5-year RFS in the TT and LT groups was 96.1% and 97.7%, respectively, and was not significantly different (P = .765). Similar results were found when excluding patients who received radioiodine ablation, which were 97.7% and 97.4%, respectively (P = .752). Age ≥55 years (hazard ratio, 7.368; P = .018) and multifocality in the ispi-lateral lobe (hazard ratio, 10.059; P =.006) were identified as independent risk factors of recurrence.

Conclusion: For unilateral TNM T1 and T2 PTC patients with lateral lymph node metastasis, there was no significant difference in the effect of TT and LT for RFS in the absence of other risk factors during the follow-up period. Patient age ≥55 years with multifocality in the unilateral lobe might be independent risk factors for prognosis.
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http://dx.doi.org/10.4158/EP-2020-0125DOI Listing
October 2020

Sex-biased DNA methylation in papillary thyroid cancer.

Biomark Med 2021 Feb 19;15(2):109-120. Epub 2021 Jan 19.

Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China 110001.

Women have a higher risk of developing papillary thyroid cancer (PTC) than men. DNA methylation is known to differ between men and women. Using the human methylation 450 BeadChip and RNA-sequence, we profiled the genome-wide DNA methylation patterns of papillary thyroid carcinoma patients and para-carcinoma tissue. We first identified 398 different expression genes (DEGs) between males and females PTC. Then we analyzed the relationship between differentially methylated positions (DMPs) and DEGs at gene promoter regions and identified 39 genes and explored DMP-DEGs' correlation with immune cell infiltration and tumor purity. We also analyzed the relationship between genomic regions and enhancers. Our study identified 39 DMP-DEGs providing some new insights into the mechanisms of methylation-mediated gender differences in PTC.
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http://dx.doi.org/10.2217/bmm-2020-0215DOI Listing
February 2021

Comparison of Outcomes Following Thyroid Isthmusectomy, Unilateral Thyroid Lobectomy, and Total Thyroidectomy in Patients with Papillary Thyroid Microcarcinoma of the Thyroid Isthmus: A Retrospective Study at a Single Center.

Med Sci Monit 2020 Dec 22;26:e927407. Epub 2020 Dec 22.

Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).

BACKGROUND Papillary thyroid microcarcinoma (PTMC) measures less than 10 mm in diameter, is more common in the thyroid lobes, but rarely presents in the thyroid isthmus. This retrospective study aimed to compare patient outcomes following various types of surgery in patients with PTMC of the thyroid isthmus, at a single center in China. MATERIAL AND METHODS We analyzed the clinical data of patients with isthmus thyroid cancer treated at the First Hospital of China Medical University. Patients were divided into 2 groups according to the tumor diameter-PTMC of the thyroid isthmus and papillary thyroid carcinoma >10 mm. The clinicopathological features between the 2 groups were compared, and the effects of various surgical methods on the prognosis of patients were analyzed. RESULTS A total of 70 patients were included in this study: 29 with PTMC of the thyroid isthmus (41.4%) and 41 with papillary thyroid carcinoma >10 mm (58.6%). The rates of lymph node metastasis (10.3% vs. 34.1%) and extrathyroid extension (0% vs. 14.6%) in the PTMC of the thyroid isthmus were significantly lower than those in the papillary thyroid carcinoma >10 mm. The recurrence-free survival (RFS) rate was 97.1%. Survival analysis showed that there was no significant difference in RFS among patients with PTMC of the thyroid isthmus undergoing isthmusectomy, unilateral lobectomy, and total thyroidectomy. CONCLUSIONS These findings from a single center showed that for patients with PTMC of the thyroid isthmus, who had no comorbidities, there was no significant difference in outcome between the 3 types of thyroid surgery.
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http://dx.doi.org/10.12659/MSM.927407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763914PMC
December 2020

Validation of a Novel NeurOs Cerebral Oximetry Monitor Against the INVOS Monitor During Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 Jul 27;35(7):2009-2018. Epub 2020 Oct 27.

Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY. Electronic address:

Objectives: To compare the performance of a novel NeurOs cerebral oximetry monitor against the INVOS monitor during the entire intraoperative phase of cardiac surgery, including periods of known fluctuation in brain oxygenation, such as preoxygenation, induction, cannulation, and cardiopulmonary bypass.

Design: This study was a prospective, nonrandomized, healthcare-provider and outcome-assessor blinded study.

Setting: Tertiary care university hospital; single institutional study.

Participants: Twenty-three patients who underwent cardiac surgery with cardiopulmonary bypass.

Interventions: Both self-adhesive INVOS sensors and the assembled NeurOs sensors were placed accordingly when the patient arrived in the operating room.

Measurements And Main Results: Ten out of 13 cases under the normal mode and eight out of the 10 cases under the high- sensitivity mode showed significant correlations between the NeurOs and INVOS groups (p < 0.05, r value from 0.24-0.88). When all cases were combined, NeurOs demonstrated significant correlation with INVOS (r = 0.5, 95% confidence interval [CI] 0.44-0.56, p < 0.01 for normal mode; r = 0.69, 95% CI 0.64 to 0.74, p < 0.01 for high-sensitivity mode) in both modes. To evaluate the data diversity, the authors performed a cluster analysis and found much less variation existed in the NeurOs normal mode when compared with INVOS (standard deviation [SD] 16.6% in INVOS, 4% in NeurOs normal mode) but similar patterns in the high-sensitivity mode (SD 17.6% in INVOS, 15.2% in NeurOs high-sensitivity mode). Bland-Altman plot analysis showed that most of the data fell between ± 1.96 SD lines, which demonstrated good consistency between these two methods under both modes of NeurOs (-28.8 to 30.8 in the normal mode; -36.6 to 32.7 in high-sensitivity mode). In the normal mode of NeurOs monitoring, receiver operating characteristic analysis suggested a 2% cutoff point was most optimal from the baseline for detecting hyperoxia (sensitivity 73%; specificity 66%) and minus 1% (sensitivity 66%; specificity 67%) for detecting hypoxia. Whereas in the high-sensitivity mode, the optimal cutoff point was 3% from baseline for detecting hyperoxia (sensitivity 75%; specificity 68%), and minus 3% for detecting hypoxia (sensitivity 90%; specificity 45%).

Conclusions: In conclusion, the novel NeurOs system was found to correlate with INVOS cerebral oximetry measurements during cardiac surgery.
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http://dx.doi.org/10.1053/j.jvca.2020.10.043DOI Listing
July 2021

Correction to: Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study.

BMC Anesthesiol 2020 Nov 9;20(1):281. Epub 2020 Nov 9.

Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, PR China.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12871-020-01196-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650153PMC
November 2020

Short-Term Outcomes of Patients With COVID-19 Undergoing Invasive Mechanical Ventilation: A Retrospective Observational Study From Wuhan, China.

Front Med (Lausanne) 2020 29;7:571542. Epub 2020 Sep 29.

Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.

COVID-19 has spread rapidly worldwide. Many patients require mechanical ventilation. The goal of this study was to investigate the clinical course and outcomes of patients with COVID-19 undergoing mechanical ventilation and identify factors associated with death. Eighty-three consecutive critically ill patients with confirmed COVID-19 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study from January 31 to March 15, 2020. Demographic, clinical, laboratory, radiological, and mechanical ventilation data were collected and analyzed. The primary outcome was 28-day mortality after endotracheal intubation. The secondary outcomes included the incidences of SARS-CoV-2-related cardiac, liver, and kidney injury. Seventy-four out of 83 (89.2%) patients achieved oxygen saturation above 93% after intubation. Forty-nine out of 83 (59%) patients died and 34 (41%) patients survived after 28 days of observation. Multivariable regression showed increasing odds of death associated with cardiac injury (odds ratio 15.60, 95% CI 4.20-74.43), liver injury (5.40, 1.46-23.56), and kidney injury (8.39, 1.63-61.41), and decreasing odds of death associated with the higher PaO/FiO ratio before intubation (0.97, 0.95-0.99). PaO/FiO ratio before intubation demonstrated a positive linear correlation with platelet count ( = 0.424, = 0.001), and negative linear correlation with troponin I ( = -0.395, = 0.008). Cardiac, liver, and kidney injury may be associated with death for critically ill patients with COVID-19 undergoing invasive mechanical ventilation. The severity of pre-intubation hypoxia may be associated with a poorer outcome of patients with COVID-19 undergoing invasive mechanical ventilation. Larger, multi-institutional, prospective studies should be conducted to confirm these preliminary results.
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http://dx.doi.org/10.3389/fmed.2020.571542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553072PMC
September 2020

Cardiovascular Changes in Patients With COVID-19 From Wuhan, China.

Front Cardiovasc Med 2020 2;7:150. Epub 2020 Sep 2.

Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.

Coronavirus disease 2019 (COVID-19) is rapidly spreading and resulting in a significant loss of life around the world. However, specific information characterizing cardiovascular changes in COVID-19 is limited. In this single-centered, observational study, we enrolled 38 adult patients with COVID-19 from February 10 to March 13, 2020. Clinical records, laboratory findings, echocardiography, and electrocardiogram reports were collected and analyzed. Of the 38 patients enrolled, the median age was 68 years [interquartile range (IQR), 55-74] with a slight female majority (21, 55.3%). Nineteen (50.0%) patients had hypertension. Seven (33.3%) had ST-T segment and T wave changes, and four (19%) had sinus tachycardia. Twenty (52.6%) had an increase in ascending aorta (AAO) diameter, 22 (57.9%) had an increase in left atrium (LA) size, and 28 (73.7%) presented with ventricular diastolic dysfunction. Correlation analysis showed that the AAO diameter was significantly associated with C-reactive protein ( = 0.4313) and creatine kinase-MB ( = 0.0414). LA enlargement was significantly associated with C-reactive protein ( = 0.4377), brain natriuretic peptide ( = 0.7612), creatine kinase-MB ( = 0.4940), and aspartate aminotransferase ( = 0.2947). Lymphocyte count was negatively associated with the AAO diameter ( = -0.5329) and LA enlargement ( = -0.3894). Hypertension was a common comorbidity among hospitalized patients with COVID-19, and cardiac injury was the most common complication. Changes in cardiac structure and function manifested mainly in the left heart and AAO in these patients. Abnormal AAO and LA size were found to be associated with severe inflammation and cardiac injury. Alternatively, ascending aortic dilation and LA enlargement might be present before infection but characterized the patient at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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http://dx.doi.org/10.3389/fcvm.2020.00150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498715PMC
September 2020

Liposomal Bupivacaine-Based Erector Spinae Block for Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 05 20;35(5):1555-1559. Epub 2020 Sep 20.

Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.

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http://dx.doi.org/10.1053/j.jvca.2020.09.115DOI Listing
May 2021

Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation.

J Cardiothorac Vasc Anesth 2021 Feb 4;35(2):389-397. Epub 2020 Sep 4.

Department of Cardiovascular Surgery. Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address:

Objective: To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19).

Design: Single-center, retrospective observation of a series of patients.

Participants: Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020.

Interventions: This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support.

Measurements And Main Results: Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8).

Conclusions: Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.
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http://dx.doi.org/10.1053/j.jvca.2020.08.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473345PMC
February 2021

Artificial Intelligence in Echocardiography for Anesthesiologists.

J Cardiothorac Vasc Anesth 2021 Jan 24;35(1):251-261. Epub 2020 Aug 24.

Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY. Electronic address:

Echocardiography is a unique diagnostic tool for intraoperative monitoring and assessment of patients with cardiovascular diseases. However, there are high levels of interoperator variations in echocardiography interpretations that could lead to inaccurate diagnosis and incorrect treatment. Furthermore, anesthesiologists are faced with the additional challenge to interpret echocardiography and make decisions in a limited timeframe from these complex data. The need for an automated, less operator-dependent process that enhances speed and accuracy of echocardiography analysis is crucial for anesthesiologists. Artificial intelligence is playing an increasingly important role in the medical field and could help anesthesiologists analyze complex echocardiographic data while adding increased accuracy and consistency to interpretation. This review aims to summarize practical use of artificial intelligence in echocardiography and discusses potential limitations and challenges in the future for anesthesiologists.
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http://dx.doi.org/10.1053/j.jvca.2020.08.048DOI Listing
January 2021

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study.

BMC Anesthesiol 2020 09 1;20(1):220. Epub 2020 Sep 1.

Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China.

Background: Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT).

Methods: Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward.

Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%).

Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

Trial Registration: Current Controlled Trials NCT03802175 , 2018/12/05, www.ClinicalTrials.gov.
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http://dx.doi.org/10.1186/s12871-020-01123-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461251PMC
September 2020

Paradoxical carbon dioxide embolism during laparoscopic surgery without intracardiac right-to-left shunt: two case reports and a brief review of the literature.

J Int Med Res 2020 Aug;48(8):300060520933816

Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.

We herein report two cases of paradoxical carbon dioxide (CO) embolism during laparoscopic nephrectomy and hepatic left lateral lobectomy without evidence of a right-to-left shunt or obvious rupture of blood vessels. Transesophageal echocardiography detected paradoxical CO embolism before the end-tidal CO partial pressure (PCO) dropped from baseline. The pneumoperitoneum was reduced or stopped immediately after detection of the embolism. One patient developed a postoperative epileptiform seizure. In the other patient, many gas bubbles were drawn out from the central venous line. We speculate that rapid introduction of pneumoperitoneum pushed a large amount of CO into the abdominal blood vessels, exceeding the gas exchange capacity of the lung and causing CO bubble formation in the left-side cardiac system. These two cases indicate that intraoperative transesophageal echocardiography can reduce the influence of CO embolism during laparoscopic tumor surgery by early diagnosis of the embolism and provide helpful information to establish a list of differential diagnoses of postoperative complications.
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http://dx.doi.org/10.1177/0300060520933816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418236PMC
August 2020

One Disaster After Another or a Timely Help? The Role of ECMO for COVID-19 Patients.

ASAIO J 2020 08;66(8):e111

Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky.

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http://dx.doi.org/10.1097/MAT.0000000000001234DOI Listing
August 2020

Preoperative Functional Platelet Number Is Inversely Associated With 30-Day Mortality After Cardiac Surgery: A Retrospective Cohort Study.

Semin Cardiothorac Vasc Anesth 2020 Dec 23;24(4):313-320. Epub 2020 Jul 23.

University of Louisville, Louisville, KY, USA.

. We hypothesize that preoperative functional platelet number (platelet count multiplied by platelet aggregation percentage) are associated with 30-day mortality after cardiac surgery. . We linked our preoperative testing database with the STS (Society of Thoracic Surgeon) database to form a study cohort of 1390 patients who had cardiac surgeries between January 2008 and December 2013. Preoperative tests of platelet count and platelet aggregation were routinely performed on all cardiac surgical patients within 24 hours before entering the operating room. Multiple logistic regression models were used to determine whether functional platelet number are associated with 30-day mortality, modified composite major adverse cardiocerebral events, postoperative renal failure or requirement for new renal replacement therapy, and reoperation for bleeding. Log-linear models were used to examine whether functional platelet numbers are associated with hospital length of stay and intensive care unit length of stay. . Functional platelet number had an inverse association with 30-day mortality, and each 50 × 10/L increase in functional platelet number resulted in decreased 30-day mortality (odds ratio of 0.767 with 95% confidence interval = 0.591-0.996). For secondary outcomes, functional platelet number was neither associated with major adverse cardiocerebral event nor length of stay. However, we found that each 50 × 10/L increase in functional platelet number was associated with decreased reoperations for bleeding (odds ratio of 0.778 with 95% confidence interval = 0.636-0.951). . The preoperative functional platelet number had significant associations with 30-day mortality after cardiac surgery. Functional platelet number could be used to guide timing of cardiac surgery, especially as more and more patients are receiving antiplatelet medications nowadays.
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http://dx.doi.org/10.1177/1089253220943023DOI Listing
December 2020

Lung ultrasound and diaphragmatic excursion assessment for evaluating perioperative atelectasis and aeration loss during video-assisted thoracic surgery: a feasibility study.

Ann Palliat Med 2020 Jul 9;9(4):1506-1517. Epub 2020 Jul 9.

Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.

Background: Although lung-protective strategies are widely used in thoracic surgery, postoperative atelectasis can still occur. Both lung ultrasound (LUS) and diaphragmatic excursion assessments are accurate and noninvasive for bedside imaging and examination. This study aimed to test the feasibility of using LUS during the perioperative period of video-assisted thoracic surgery (VATS) and to continuously evaluate aeration changes through LUS examination and diaphragmatic excursion assessment.

Methods: Between January 2019 and May 2019, data were prospectively collected from patients that were scheduled to undergo a VATS with one-lung ventilation (OLV). LUS was performed at four specific timepoints: before the induction of general anesthesia (timepoint A), 5 minutes after intubation (timepoint B), at the end of surgery (timepoint C), and 15 minutes after extubation (timepoint D). Diaphragmatic excursion assessment was performed only at the first (timepoint A) and last timepoints (timepoint D) for the use of paralytics during surgery.

Results: This study included 80 consecutive patients (37 men, 43 women). Among them were patients undergoing lobectomy (14 patients; 17.5%), segmentectomy (35 patients, 43.8%), wedge resection (19 patients; 23.8%), or mediastinal tumor resection (12 patients, 15.0%). LUS was possible for all patients. As a result, LUS helped detect postoperative atelectasis in 12 patients (15.0%). Among them were 4 (33.3%) lung resection patients and 8 (66.7%) mediastinal tumor resection patients. Pneumothorax and small effusions were also diagnosed through LUS examination. There was significant aeration loss throughout the surgery from the start of induction (P<0.001). We discovered that changes in LUS scores were found to be associated with an increase of diaphragmatic excursions after assessment (Spearman's r=-0.54, P<0.001).

Conclusions: LUS is feasible during all phases of the perioperative period in VATS and can facilitate the early investigation of perioperative atelectasis. Perioperative LUS and diaphragmatic excursion assessment are also feasible for the continuous assessment of aeration loss in patients undergoing VATS.
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http://dx.doi.org/10.21037/apm-19-595bDOI Listing
July 2020

Propensity score specification for optimal estimation of average treatment effect with binary response.

Stat Methods Med Res 2020 12 8;29(12):3623-3640. Epub 2020 Jul 8.

Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA.

Propensity score methods are commonly used in statistical analyses of observational data to reduce the impact of confounding bias in estimations of average treatment effect. While the propensity score is defined as the conditional probability of a subject being in the treatment group given that subject's covariates, the most precise estimation of average treatment effect results from specifying the propensity score as a function of true confounders and predictors only. This property has been demonstrated via simulation in multiple prior research articles. However, we have seen no theoretical explanation as to why this should be so. This paper provides that theoretical proof. Furthermore, this paper presents a method for performing the necessary variable selection by means of elastic net regression, and then estimating the propensity scores so as to obtain optimal estimates of average treatment effect. The proposed method is compared against two other recently introduced methods, outcome-adaptive lasso and covariate balancing propensity score. Extensive simulation analyses are employed to determine the circumstances under which each method appears most effective. We applied the proposed methods to examine the effect of pre-cardiac surgery coagulation indicator on mortality based on a linked dataset from a retrospective review of 1390 patient medical records at Jewish Hospital (Louisville, KY) with the Society of Thoracic Surgeons database.
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http://dx.doi.org/10.1177/0962280220934847DOI Listing
December 2020

UNILATERAL TNM T1 AND T2 THYROID PAPILLARY CARCINOMA WITH LATERAL CERVICAL LYMPH NODE METASTASIS: TOTAL THYROIDECTOMY OR LOBECTOMY?

Endocr Pract 2020 Jun 23. Epub 2020 Jun 23.

From: Department of Thyroid Surgery, The First Hospital of China Medical University, No.155, Nanjing Bei Street, Heping District Shenyang, Liaoning Province, 110001, China.

: The aim of this study was to explore the effect of total thyroidectomy (TT) and lobectomy (LT) on the prognosis of unilateral papillary thyroid carcinoma (PTC)with lateral cervical lymph node metastasis. : Patients with PTC and lateral cervical lymph node metastasis who underwent lateral cervical lymph node dissection between January 2007 and December 2016 were retrospectively reviewed. To investigate the effect of surgical procedure on the prognosis of lymph node metastasis patients, other high-risk factors such as extrathyroidal invasion and large tumor size were excluded. All patients were in TNM stage T1 and T2. Primary end point was recurrence free survival (RFS). : Among 264 PTC patients, 104 (39.4%) patients received TT and 160 (60.6%) patients received LT. With a median follow-up of 50 months (interquartile range34 to 74), 7 patients (2.65%) experienced recurrence. The 5-year RFS in the TT and LT groups were 96.1% and 97.7% respectively and was not significantly different (=0.765). Similar results were found when excluding patients who received radioiodine ablation (RAI) which were 97.7% and 97.4% respectively (=0.752). Age≥55 (hazard ratio=7.368, =0.018) and multifocality in the ispilateral lobe (hazard ratio=10.059, =0.006) were identified as independent risk factors of recurrence. : For unilateral TNM T1 and T2 PTC patients with lateral lymph node metastasis, there was no significant difference in the effect of TT and LT for RFS in the absence of other risk factors during follow up period. Patient with age≥55 and multifocality in unilateral lobe might be an independent risk factor for prognosis.
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http://dx.doi.org/10.4158/EP-2020-0125DOI Listing
June 2020

Chinese Association of Anesthesiologists Expert Consensus on the Use of Perioperative Ultrasound in Coronavirus Disease 2019 Patients.

J Cardiothorac Vasc Anesth 2020 07 10;34(7):1727-1732. Epub 2020 Apr 10.

Anesthesia and Surgery Center, Chinese PLA General Hospital, Beijing, China.

The COVID-19 pandemic is spreading globally. COVID-19 has an effect on the systemic state, cardiopulmonary function and primary disease of patients undergoing surgery. COVID-19's high contagiousness makes anesthesia and intraoperative management more difficult. This expert consensus aims to comprehensively introduce the application of perioperative ultrasound in COVID-19 patients, including pulmonary ultrasound and anesthesia management, ultrasound and airway management, ultrasound-guided regional anesthesia and echocardiography for COVID-19 patients.
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http://dx.doi.org/10.1053/j.jvca.2020.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194578PMC
July 2020