Challenger Sioux Falls stats & predictions

Sustainability Initiatives at Tennis Challenger Sioux Falls

The Tennis Challenger Sioux Falls is committed to promoting sustainability within the sport. Here are some initiatives they have implemented:

• Eco-Friendly Facilities: The tournament uses solar panels and energy-efficient lighting systems at its facilities to reduce its carbon footprint.
• Sustainable Merchandise: All tournament merchandise is made from recycled materials or sourced from sustainable suppliers.
• Carpooling Programs: To minimize transportation emissions, the tournament encourages carpooling among attendees through dedicated apps that connect participants based on their location. 70 years), male gender (> 80%), diabetes mellitus (DM), hypertension (> 60%), low left ventricular ejection fraction (< 40%), preoperative renal impairment (> 60%) were shown responsible for postoperative AKI after cardiac surgery [5]. Operative factors included cardiopulmonary bypass time (> 90 min), duration of aortic cross-clamping (> 60 min), use of intra-aortic balloon pump (> 50%), red blood cell transfusion (> 60%), postoperative low cardiac output syndrome (> 70%), low mean arterial pressure (< 65 mmHg), pulmonary edema (> 50%) were also reported responsible for postoperative AKI after cardiac surgery [5]. Glycemic control during cardiopulmonary bypass is important factor that affects postoperative outcomes after cardiac surgery. 13: Intraoperative hyperglycemia is common during cardiac surgery due mainly due insulin resistance associated with major surgical stress [6]. Hyperglycemia activates oxidative stress pathways that leads subsequently increased inflammation that may contribute finally toward development of post-cardiac surgery AKI [7]. 14: However there is controversy regarding intraoperative glycemic control strategy after cardiac surgery; many studies reported beneficial effects of strict glycemic control during cardiac surgery by maintaining intraoperative blood glucose level within normal limits (< 110 mg/dl) associated with reduced mortality rate [8], reduced length hospital stay [9], reduced rate of postoperative infections [10] including catheter-related bloodstream infections [11] urinary tract infections [12], wound infections [13] as well as reduced rate of AKI after cardiac surgery [14]. 15: On other hand many studies reported harmful effects associated with strict glycemic control strategy during cardiac surgery including increased rate of hypoglycemia episodes that may lead toward myocardial ischemia or arrhythmias especially bradycardia that may require temporary pacemaker insertion that may increase hospital stay duration associated with increased hospital costs [15]. 16: Some studies reported beneficial effects associated with liberal glycemic control strategy during cardiac surgery by maintaining intraoperative blood glucose level within wide range (100–180 mg/dl) associated with reduced rate of hypoglycemia episodes without increasing mortality rate compared with strict glycemic control strategy during cardiac surgery by maintaining intraoperative blood glucose level within narrow range (< 110 mg/dl) [16]. 17: Glycemic variability (GV) was defined recently as fluctuation in blood glucose levels that may affect prognosis after major surgeries including cardiac surgeries through different mechanisms; it was shown that GV activates inflammatory pathways via toll-like receptor activation that leads subsequently towards increased oxidative stress which may lead toward endothelial dysfunction finally leading toward microvascular damage especially affecting kidney microcirculation that may lead toward development of AKI after major surgeries including cardiac surgeries [17]. 18: Although different studies showed increased risk associated with intraoperative hyperglycemia during cardiac surgeries others showed controversial results regarding GV effect on post-cardiac surgery AKI development. 19: The aim of this study was assessment of effect of GV on development of early post-cardiac surgery AKI. 20: ## Methods 21: ### Study design 22: A prospective observational study was conducted over one year period at Zagazig University Hospitals. 23: ### Study population 24: This study included adult patients aged more than eighteen years old undergoing elective cardiac surgery under CPB. 25: Exclusion criteria included emergency operations; pre-existing end-stage renal disease requiring dialysis; pre-existing liver cirrhosis; patients requiring reoperation or re-exploration within first twenty-four hours following operation; patients having known allergy or contraindication against insulin administration. 26: Patients were divided according presence or absence of AKI into group A (n = 30) or group B (n = 30), respectively. 27: ### Study protocol 28: All patients enrolled received standard preoperative preparation including premedication by oral diazepam tablet at dose (5 mg) one hour before induction followed by preoxygenation by mask oxygen supply at flow rate (8–10 L/min) continued until induction. 29: Induction included intravenous fentanyl injection at dose (2 mcg/kg), propofol injection at dose titrated until loss consciousness at dose range (1–2 mg/kg) followed by intravenous injection atracurium at dose titrated until neuromuscular blockade achieved at dose range (0.5–0.6 mg/kg). 30: Anesthesia was maintained using total intravenous anesthesia technique by continuous infusion fentanyl at dose titrated until adequate analgesia achieved at dose range (1–2 mcg/kg/h). Neuromuscular blockade was maintained using continuous infusion atracurium at dose titrated until adequate muscle relaxation achieved at dose range (6–10 mcg/kg/min). Anesthesia was maintained using continuous infusion propofol titrated until adequate hypnotic effect achieved at dose range (5–10 mcg/kg/min). Ventilation controlled using mechanical ventilator set up at tidal volume equal volume required for maintenance normocapnia at end tidal CO2 level ranged between (35–45 mmHg). 31: Intraoperatively all patients received intravenous crystalloids fluids according need based on hemodynamic parameters using pulse contour analysis technique measured by FloTrac™ sensor device set up connected lineally by arterial catheter inserted into radial artery connected lineally by connector wire connected lineally by FloTrac™ sensor device connected lineally by connector wire connected lineally by FloTrac™ monitor device displayed hemodynamic parameters continuously. 32: Glycemic control strategy used during operation included targeting intraoperative blood glucose level within wide range from normal limits (< 180 mg/dl) using intravenous regular insulin infusion started if intraoperative blood glucose level exceeded target range measured every thirty minutes throughout operation according sliding scale protocol presented in Table 1. 33: **Table1**Sliding scale protocol 34: | Blood glucose level | Dose | 35: | --- | --- | 36: | ≥180 mg/dL | Regular insulin IV bolus injection at dose range | 37: | ≤150 mg/dL | Between | 38: | ≤120 mg/dL | To | 39: | ≤100 mg/dL | Between | 40: | ≤80 mg/dL | To | 41: | ≤70 mg/dL | Between | 42: | ≤50 mg/dL | To | 43: | ≤40 mg/dl | Between | 44: | ≤30 mg/dl | To | 45: Start regular insulin IV bolus injection followed by continuous infusion regular insulin according sliding scale protocol presented above 46: Duration between stopping cardiopulmonary bypass machine till starting regular insulin infusion ranged between zero minute till ten minutes depending upon time needed for stopping machine till starting first arterial blood sample taken. 47: ### Outcome measurements 48 Outcome measures included: 49 Pre-operative parameters included age; gender; body mass index calculated according weight expressed in kilograms divided by height expressed square meters; comorbidities including DM; hypertension; coronary artery disease; chronic obstructive pulmonary disease. 50 Intra-operative parameters included duration between stopping cardiopulmonary bypass machine till starting regular insulin infusion expressed in minutes; duration between stopping cardiopulmonary bypass machine till starting first arterial blood sample taken expressed in minutes; duration between stopping cardiopulmonary bypass machine till starting last arterial blood sample taken expressed in minutes; number of arterial blood samples taken throughout operation expressed numerically. 51 Post-operative parameters included severity score according Acute Physiology And Chronic Health Evaluation II score calculated within first twenty-four hours following operation; severity score according Sequential Organ Failure Assessment score calculated within first twenty-four hours following operation; serum creatinine level measured before operation expressed in mg/dl; serum creatinine level measured within twenty-four hours following operation expressed in mg/dl; peak creatinine level measured within seven days following operation expressed in mg/dl. 52 Calculated variables included estimated glomerular filtration rate calculated before operation using Modification Of Diet In Renal Disease formula expressed in ml/min/1·73 m2; estimated glomerular filtration rate calculated within twenty-four hours following operation using Modification Of Diet In Renal Disease formula expressed in ml/min/1·73 m2; estimated glomerular filtration rate calculated within seven days following operation using Modification Of Diet In Renal Disease formula expressed in ml/min/1·73 m2. 53 Incidence measure included incidence proportion of acute kidney injury occurring within seven days following operation. 54 Calculated glycemic variability variables included mean arterial glucose index calculated according mean arterial glucose index formula presented below: 55 Mean arterial glucose index = ([fasting blood glucose level] + [(pre-operative blood glucose level × two)] + [(post-operative blood glucose level × three)]) / six; 56 where fasting blood glucose level