Multicenter Evaluation of the Quantra QPlus System in Adult Patients Undergoing Major Surgical Procedures
ANESTHESIA AND ANALGESIA
Authors: Groves, Danja S.; Welsby, Ian J.; Naik, Bhiken I.; Tanaka, Kenichi; Hauck, Jennifer N.; Greenberg, Charles S.; Winegar, Deborah A.; Viola, Francesco
Abstract
BACKGROUND: The management of perioperative bleeding and the optimization of the available therapies are subjects of significant clinical interest. Clinical guidelines recommend the use of whole blood viscoelastic testing devices to target the utilization of blood products during major surgical procedures. The Quantra QPlus System is a new cartridge-based viscoelastic testing device based on an innovative ultrasound technology. The aim of this study was to evaluate this new system in a surgical population. METHODS: Two hundred seventy-seven adult subjects were enrolled in a multicenter, prospective observational study consisting primarily of patients undergoing cardiac and major orthopedic surgeries. Samples were obtained at multiple time points for testing on the Quantra QPlus System, the rotational thromboelastometry (ROTEM) delta, and standard coagulation tests. Quantra measurements included Clot Time (CT), Heparinase Clot Time (CTH), Clot Time Ratio (CTR), Clot Stiffness (CS), Fibrinogen (FCS), and Platelet (PCS) Contributions to CS. Data analyses included assessment of the concordance of Quantra parameters with a series of clinical composite indexes formed on the basis of standard coagulation tests in 3 domains representing increased, decreased, and normal/subclinical coagulation function. Linear regression and receiver operator characteristic (ROC) analyses of Quantra parameters with corresponding parameters from ROTEM assays were also performed. RESULTS: The accuracy (overall percent agreement or ratio of true positives and true negatives over the entire population) between the Quantra and the composite indexes was between 72% and 98% depending on the specific parameter. Linear regression analysis indicated that the correlation between ROTEM delta and Quantra was very strong with r values ranging between 0.84 and 0.89. Results from ROC analysis demonstrated sensitivities and specificities in the 80%-90% range when QPlus parameters were used to discriminate ROTEM threshold values currently used in goal-directed treatment algorithms. CONCLUSIONS: This study demonstrated that the Quantra QPlus System is strongly correlated with a well-established viscoelastic testing device and its parameters effectively represent the results from multiple standard laboratory assays. The Quantra has been designed to operate at the point of care with the potential to provide rapid and comprehensive results to aid in the management of coagulopathic patients.
Description of the structure-chemoselectivity relationship in the transfer hydrogenation of alpha,beta-unsaturated aldehydes and ketones with alcohols in the presence of magnesium oxide
APPLIED CATALYSIS A-GENERAL
Authors: Glinski, Marek; Ulkowska, Urszula
Abstract
The vapour-phase catalytic transfer hydrogenation (CTH) of fifteen acyclic alpha,beta-unsaturated carbonyl compounds, i.e. ten aldehydes and five ketones, with ethanol or 2-propanol as hydrogen donors has been studied over pure MgO as the catalyst. The obtained values of the yields of unsaturated alcohols (UOLs) have been used to calculate a normalized value called the relative directional reactivity (RDR). Among substituted alpha,beta-unsaturated aldehydes transfer hydrogenated with ethanol only two of them have shown a lower reactivity (RDRE < 1) than that noted for acrolein (for which RDRE = 1), namely 3,3-dimethyl- and 2-phenylacrolein. It has been found that the introduction of an alkyl substituent into position 2 in an acrolein molecule as well as a phenyl group into position 3 leads to a distinct increase of an RDRE value for such aldehydes. In contrast, very pronounced differences in relative directional reactivity values (RDIRp) for both alpha,beta-unsaturated aldehydes and ketones have been observed when 2-propanol was used as the hydrogen donor. The ranges of the RDRp values are: 0.45-2.52 and 0.04-1.71 for aldehydes and ketones, respectively. The proposed normalization procedure allowed us to obtain values which could be used to make meaningful conclusions as to the influence of the structure of alpha, beta-unsaturated carbonyl compounds on their reactivity. Moreover, it was used to determine which of these compounds react in accordance with the thermodynamic description, and whose reactivity is kinetically controlled.