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Pubblicazioni recenti - cardiac surgery
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Awake extracorporeal life support and physiotherapy in adult patients: A systematic review of the literature.
Perfusion2022 Jun;():2676591221096078. doi: 10.1177/02676591221096078.
Cucchi Marta, Mariani Silvia, De Piero Maria E, Ravaux Justine M, Kawczynski Michal J, Di Mauro Michele, Shkurka Emma, Hoskote Aparna, Lorusso Roberto,
Abstract
OBJECTIVE:
The Awake Extracorporeal Life Support (ECLS) practice combined with physiotherapy is increasing. However, available evidence for this approach is limited, with unclear indications on timing, management, and protocols. This review summarizes available literature regarding Awake ECLS and physiotherapy application rates, practices, and outcomes in adults, providing indications for future investigations.
METHODS:
Four databases were screened from inception to February 2021, for studies reporting adult Awake ECLS with/without physiotherapy. Primary outcome was hospital discharge survival, followed by Extracorporeal Membrane Oxygenation (ECMO) duration, extubation, Intensive Care Unit stay.
RESULTS:
Twenty-nine observational studies and one randomized study were selected, including 1,157 patients (males = 611/691, 88.4%) undergoing Awake ECLS. Support type was reported in 1,089 patients: Veno-Arterial ECMO (V-A = 39.6%), Veno-Venous ECMO (V-V = 56.8%), other ECLS (3.6%). Exclusive upper body cannulation and femoral cannulation were applied in 31% versus 69% reported cases ( = 931). Extubation was successful in 63.5% ( = 522/822) patients during ECLS. Physiotherapy details were given for 676 patients: exercises confined in bed for 47.9% ( = 324) patients, mobilization until standing in 9.3% ( = 63) cases, ambulation performed in 42.7% ( = 289) patients. Femoral cannulation, extubation and V-A ECMO were mostly correlated to complications. Hospital discharge survival observed in 70.8% ( = 789/1114).
CONCLUSION:
Awake ECLS strategy associated with physiotherapy is performed regardless of cannulation approach. Ambulation, as main objective, is achieved in almost half the population examined. Prospective studies are needed to evaluate safety and efficacy of physiotherapy during Awake ECLS, and suitable patient selection. Guidelines are required to identify appropriate assessment/evaluation tools for Awake ECLS patients monitoring.
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Non-ischaemic cardiomyopathy associated with elevated serum cobalt and accelerated wear of a metal-on-metal hip resurfacing.
BMJ Case Rep2022 Jun;15(6):. doi: e249070.
Rahman Tahsin M, Hall Deborah J, Darrith Brian, Liu Songyun, Jacobs Joshua J, Pourzal Robin, Silverton Craig D,
Abstract
A man in his late 30s developed non-ischaemic cardiomyopathy due to systemic cobalt toxicity associated with accelerated bearing surface wear from metal-on-metal hip resurfacing implanted in the previous 6 years. Following revision arthroplasty, the patient regained baseline cardiac function. Cobalt-induced cardiomyopathy is a grave condition that deserves early consideration due to potentially irreversible morbidity. We present this case to increase awareness, facilitate early detection and emphasise the need for research into the diagnosis and management of at-risk patients.
© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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Accuracy and Safety of Neuronavigation for Minimally Invasive Stabilization in the Thoracolumbar Spine Using Polyaxial Screws-Rod: A Canine Cadaveric Proof of Concept.
Vet Comp Orthop Traumatol2022 Jun;():. doi: 10.1055/s-0042-1750056.
Guevar Julien, Samer Eva S, Precht Christina, Rathmann Justus Mk, Forterre Franck,
Abstract
OBJECTIVES:
?The main aim of this study was to evaluate the feasibility of minimally invasive stabilization with polyaxial screws-rod using neuronavigation and to assess accuracy and safety of percutaneous drilling of screw corridors using neuronavigation in thoracolumbar spine and compare it between an experienced and a novice surgeon.
STUDY DESIGN:
?Feasibility of minimally invasive polyaxial screws-rod fixation using neuronavigation was first performed in the thoracolumbar spine of two dogs. Accuracy and safety of drilling screw corridors percutaneously by two surgeons from T8 to L7 in a large breed dog using neuronavigation were established by comparing entry and exit points coordinates deviations on multiplanar reconstructions between preoperative and postoperative datasets and using a vertebral cortical breach grading scheme.
RESULTS:
?Feasibility of minimally invasive stabilization was demonstrated. For the experienced surgeon, safety was 100% and mean (standard deviation) entry point deviations were 0.3?mm (0.8?mm) lateral, 1.3?mm (0.8?mm) ventral and 0.7?mm (1.8?mm) caudal. The exit points deviations were 0.8?mm (1.9?mm) lateral, 0.02?mm (0.9?mm) dorsal and 0.7?mm (2.0?mm) caudal. Significant difference in accuracy between surgeons was found in the thoracic region but not in the lumbar region. Accuracy and safety improvement are noted for the thoracic region when procedures were repeated by the novice.
CONCLUSION:
?This proof of concept demonstrates that using neuronavigation, minimally invasive stabilization with polyaxial screws-rod is feasible and safe in a large breed dog model.
Thieme. All rights reserved.
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Oncological liver resection in elderly - A retrospective comparative study.
Int J Surg2022 Jun;():106729. doi: S1743-9191(22)00506-4.
Riediger Carina E, Löck Steffen, Frohneberg Laura, Hoffmann Raphael, Kahlert Christoph, Weitz Jürgen,
Abstract
BACKGROUND:
Due to demographic changes and higher life expectancy especially in industrial nations, the number of liver resections in patients ?70 years is rising. It is known that older age is associated with higher postoperative morbidity and mortality after surgery under general anesthesia. The aim of this analysis is to compare the postoperative outcome after liver resections for malignancies in patients aged below and above 70 years.
MATERIALS AND METHODS:
A prospectively collected electronic database of 1034 liver resections between 01/2013 and 12/2019 was retrospectively analyzed. Comparative analysis of patients
RESULTS:
Median age of the whole cohort was 65 years (range 18-87 years). N?=?582 liver resections (65.7%) were performed in patients
CONCLUSION:
Liver resections in patients ?70 years are associated with a worse postoperative course after. Parenchyma sparing resections should be preferred in those patients.
Copyright © 2022. Published by Elsevier Ltd.
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HDAC1 Promotes Myocardial Fibrosis in Diabetic Cardiomyopathy by Inhibiting BMP-7 Transcription Through Histone Deacetylation.
Exp Clin Endocrinol Diabetes2022 Jun;():. doi: 10.1055/a-1780-8768.
Ouyang Chun, Huang Lei, Ye Xiaoqiang, Ren Mingming, Han Zhen,
Abstract
OBJECTIVE:
Diabetic cardiomyopathy (DCM) constitutes a primary cause of mortality in diabetic patients. Histone deacetylase (HDAC) inhibition can alleviate diabetes-associated myocardial injury. This study investigated the mechanism of HDAC1 on myocardial fibrosis (MF) in DCM.
METHODS:
A murine model of DCM was established by a high-fat diet and streptozotocin injection. The bodyweight, blood glucose, serum insulin, and cardiac function of mice were analyzed. Lentivirus-packaged sh-HDAC1 was injected into DCM mice and high glucose (HG)-induced cardiac fibroblasts (CFs). The pathological structure of the myocardium and the level of myocardial fibrosis were observed by histological staining. HDAC1 expression in mouse myocardial tissues and CFs was determined. Collagen I, collagen III, alpha-smooth muscle actin (?-SMA), and vimentin levels in CFs were detected, and CF proliferation was tested. HDAC activity and histone acetylation levels in tissues and cells were measured. Bone morphogenetic protein-7 (BMP-7) expression in myocardial tissues and CFs was determined. Functional rescue experiments were conducted to confirm the effects of histone acetylation and BMP-7 on myocardial fibrosis.
RESULTS:
DCM mice showed decreased bodyweight, elevated blood glucose and serum insulin, and cardiac dysfunction. Elevated HDAC1 and reduced BMP-7 expressions were detected in DCM mice and HG-induced CFs. HDAC1 repressed BMP-7 transcription through deacetylation. HDAC1 silencing alleviated MF, reduced CF proliferation and decreased collagen I, -III, ?-SMA, and vimentin levels. However, reducing histone acetylation level or BMP-7 downregulation reversed the effects of HDAC1 silencing on CF fibrosis.
CONCLUSION:
HDAC1 repressed BMP-7 transcription by enhancing histone deacetylation, thereby promoting MF and aggravating DCM.
Thieme. All rights reserved.
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Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19.
J Am Soc Echocardiogr2022 Jun;():. doi: S0894-7317(22)00310-8.
Young Kathleen A, Krishna Hema, Jain Vaibhav, Hamza Izhan, Scott Christopher G, Pellikka Patricia A, Villarraga Hector R,
Abstract
BACKGROUND:
Strain analysis of transthoracic echocardiography (TTE) is a sensitive tool to detect myocardial dysfunction in those affected by COVID-19. Consideration of pre-existing cardiovascular disease is important in detecting changes related to COVID-19. We sought to assess serial TTE changes in patients recovered from COVID-19 compared to baseline, pre-COVID-19 exams, with a focus on left and right ventricular longitudinal strain.
METHODS:
In this retrospective review of serial TTEs in confirmed COVID-19 patients at Mayo Clinic sites, included patients had a TTE within 2 years prior to confirmed COVID-19 diagnosis and the first available outpatient TTE after diagnosis used as comparison. Patients with interval cardiac surgery, procedure, or device placement (n=9) were excluded. Biventricular strain was retrospectively performed on both echocardiograms.
RESULTS:
Of 259 individuals, age 60±16 years, 47% female, and 88% Caucasian, post-COVID-19 TTEs were performed a median of 55 days (IQR 37-92) following diagnosis. No clinically significant TTE changes were noted, though left ventricular ejection fraction (LVEF) was higher (58% vs 57%, p=0.049) and tricuspid annulus plane systolic excursion lower (20 vs 21mm, p=0.046) following COVID-19. Baseline LV global longitudinal strain (LV GLS) and right ventricular free wall strain (RV FWS) were normal (-19.6% and -25.8%, respectively) and similar following COVID-19 (-19.6% and -25.7%, p=0.07 and 0.77, respectively). In the 74 inpatients, no significant change from baseline was seen for LV GLS (-19.4% vs -19.1%, p=0.62), RV FWS (-25.5% vs -25.0%, p=0.69), or LVEF (57% vs 57%, p=0.71). A significant worsening in strain occurred in 27 patients, 16 (6.8%) of the 237 with LV GLS and 14 (6.0%) of the 235 with RV FWS. Ten (20%) patients reporting new symptoms following COVID-19 had worsened strain, compared to 5 (7%) with persistent/progressive symptoms and 11 (9%) with no new symptoms (p=0.04).
CONCLUSIONS:
While patients with new symptoms following COVID-19 were more likely to have a worsening in absolute strain values, no clinically significant change in TTE parameters was evident in most patients following COVID-19 regardless of symptom status.
Copyright © 2022. Published by Elsevier Inc.
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Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018.
Diabetes Res Clin Pract2022 Jun;():109972. doi: S0168-8227(22)00786-0.
Lauwers Patrick, Wouters Kristien, Vanoverloop Johan, Avalosse Hervé, Hendriks Jeroen, Nobels Frank, Dirinck Eveline, ,
Abstract
AIMS:
This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates.
METHODS:
Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk.
RESULTS:
41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95%CI 0.96-0.98, p
CONCLUSIONS:
A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.
Copyright © 2022. Published by Elsevier B.V.
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Effects of Multimodal Inpatient Rehabilitation vs. Conventional Pulmonary Rehabilitation on Physical Recovery after Esophageal Cancer Surgery.
Arch Phys Med Rehabil2022 Jun;():. doi: S0003-9993(22)00474-9.
Do Jung Hwa, Gelvosa Ma Nessa, Choi Kyung Yong, Kim Hwal, Kim Ja Young, Stout Nicole L, Cho Young Ki, Kim Hyeong Ryul, Kim Yong-Hee, Kim Sang Ah, Jeon Jae Yong,
Abstract
OBJECTIVE:
To determine the effects of multimodal rehabilitation initiated immediately after esophageal cancer surgery on physical recovery compared to conventional pulmonary rehabilitation.
DESIGN:
Retrospective study.
SETTING:
Private quaternary care hospital.
PARTICIPANTS:
Fifty-nine inpatients who participated in either conventional pulmonary rehabilitation (n?=?30) or in multimodal rehabilitation (n?=?29) after esophageal cancer surgery were included.
INTERVENTIONS:
Both groups performed pulmonary exercises, including deep breathing, chest expansion, inspiratory muscle training, coughing, and manual vibration. In the conventional pulmonary rehabilitation group, light-intensity mat exercise, stretching, and walking were performed. The multimodal rehabilitation group performed resistance exercises and moderate-to-high-intensity aerobic interval exercises using a bicycle.
MAIN OUTCOME MEASURES:
The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), pain, 6-minute walk test (6MWT), 30-second chair stand test, and grip strengths were assessed before and after the rehabilitation programs.
RESULTS:
Symptom scales of pain, dyspnea, and insomnia in the EORTC QLQ C-30 as well as 6MWT improved significantly after each program (p
CONCLUSIONS:
A multimodal inpatient rehabilitation program instituted early after esophageal cancer surgery improved endurance for walking as measured by the 6MWT as well as the 30-second chair stand test, more than conventional pulmonary rehabilitation.
Copyright © 2022. Published by Elsevier Inc.
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Folic acid-mediated MSNs@Ag@Geb multifunctional nanocomposite heterogeneous platform for combined therapy of non-small cell lung cancer.
Colloids Surf B Biointerfaces2022 Jun;217():112639. doi: S0927-7765(22)00322-8.
Lin Jianbo, Zheng Rujie, Huang Liping, Tu Yuanrong, Li Xu, Chen Jianfeng,
Abstract
Molecularly targeted drugs are flourishing in the clinical treatment of non-small cell lung cancer (NSCLC). However, the treatment of a single drug (such as Gefitinib (Geb)) had defects such as poor pharmacokinetics, insufficient drug delivery, and considerable toxic side effects, which greatly affect its therapeutic efficacy against NSCLC. To solve these issues, this study developed a new nanocomposite heterogeneous platform (MSNs@Ag@Geb-FA) that combined photothermal therapy and molecular targeted therapy. The high specific surface area empowered mesoporous silicon dioxide (SiO) heterostructure the ability to efficiently load Ag photothermal agents and anti-tumor drug Geb. Meanwhile, a favorable pH response (degradation of residual MnO) achieved the controlled release of Ag and Geb. Besides, the targeting and endocytosis properties of nano drugs were greatly improved through the modification of folic acid (FA). Both in vivo and in vitro experiments authenticated that this nanocomposite heterogeneous platform could effectively integrate the multiple tumor suppressor properties of Ag nanoparticles and cooperate with Geb to hasten A549 cell apoptosis, thereby achieving a favorable anti-tumor effect. This heterogeneous structure of the nanocomposite heterogeneous platform could provide an effective strategy for the treatment of NSCLC.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Machine learning decision tree algorithm role for predicting mortality in critically ill adult COVID-19 patients admitted to the ICU.
J Infect Public Health2022 Jun;15(7):826-834. doi: S1876-0341(22)00151-4.
Elhazmi Alyaa, Al-Omari Awad, Sallam Hend, Mufti Hani N, Rabie Ahmed A, Alshahrani Mohammed, Mady Ahmed, Alghamdi Adnan, Altalaq Ali, Azzam Mohamed H, Sindi Anees, Kharaba Ayman, Al-Aseri Zohair A, Almekhlafi Ghaleb A, Tashkandi Wail, Alajmi Saud A, Faqihi Fahad, Alharthy Abdulrahman, Al-Tawfiq Jaffar A, Melibari Rami Ghazi, Al-Hazzani Waleed, Arabi Yaseen M,
Abstract
BACKGROUND:
Coronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is currently a major cause of intensive care unit (ICU) admissions globally. The role of machine learning in the ICU is evolving but currently limited to diagnostic and prognostic values. A decision tree (DT) algorithm is a simple and intuitive machine learning method that provides sequential nonlinear analysis of variables. It is simple and might be a valuable tool for bedside physicians during COVID-19 to predict ICU outcomes and help in critical decision-making like end-of-life decisions and bed allocation in the event of limited ICU bed capacities. Herein, we utilized a machine learning DT algorithm to describe the association of a predefined set of variables and 28-day ICU outcome in adult COVID-19 patients admitted to the ICU. We highlight the value of utilizing a machine learning DT algorithm in the ICU at the time of a COVID-19 pandemic.
METHODS:
This was a prospective and multicenter cohort study involving 14 hospitals in Saudi Arabia. We included critically ill COVID-19 patients admitted to the ICU between March 1, 2020, and October 31, 2020. The predictors of 28-day ICU mortality were identified using two predictive models: conventional logistic regression and DT analyses.
RESULTS:
There were 1468 critically ill COVID-19 patients included in the study. The 28-day ICU mortality was 540 (36.8 %), and the 90-day mortality was 600 (40.9 %). The DT algorithm identified five variables that were integrated into the algorithm to predict 28-day ICU outcomes: need for intubation, need for vasopressors, age, gender, and PaO2/FiO2 ratio.
CONCLUSION:
DT is a simple tool that might be utilized in the ICU to identify critically ill COVID-19 patients who are at high risk of 28-day ICU mortality. However, further studies and external validation are still required.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Length of Stay and 30-Day Postoperative Complications Following Minimally Invasive Apical Prolapse Repair.
Female Pelvic Med Reconstr Surg2022 Jun;():. doi: 10.1097/SPV.0000000000001205.
Dieter Alexis A, Moore Kristin J, Willis-Gray Marcella G, Gutman Robert E, Iglesia Cheryl B, Carey Erin T,
Abstract
IMPORTANCE:
Data on the correlation between length of stay and postoperative complications following urogynecologic surgery are limited.
OBJECTIVES:
The objective of this study was to use a nationwide database to examine the correlation between length of stay and 30-day postoperative complications following minimally invasive apical prolapse repair.
STUDY DESIGN:
This retrospective cohort study included women in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2018 who underwent laparoscopic/robotic sacrocolpopexy or uterosacral/sacrospinous repair and were discharged on postoperative day 0 (POD0) or 1 (POD1). The primary outcome was 30-day postoperative complication rate.
RESULTS:
Of the 28,269 women discharged home on POD0/1, 12,663 (45%) underwent laparoscopic/robotic sacrocolpopexy, and 15,606 (55%) underwent uterosacral/sacrospinous repair. Women discharged on POD0 were less likely to be White, less likely to have diabetes or hypertension, had lower mean body mass index, and were less likely to have undergone a hysterectomy (P
CONCLUSIONS:
In women undergoing minimally invasive reconstructive apical repair, discharge on POD0 is correlated with similar or better (lower) 30-day postoperative complication rates compared with women discharged on POD1.
Copyright © 2022 American Urogynecologic Society. All rights reserved.
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[Comment on article: "Blood products with autologous transfusion versus allogeneic transfusion in cardiac surgery patients"].
Rev Med Inst Mex Seguro Soc2022 May;60(3):246.
Campos-Aguirre Esmeralda,
Abstract
Evaluating transfusion options helps reduce the use of blood products and improve their distribution. The study "Blood products with autologous transfusion versus allogeneic transfusion in cardiac surgery patients" shows a comparison between the options available to improve blood management in patients in the surgical stage. We ask the authors for more information on the data analysis performed to improve the understanding of the conclusions obtained.
© 2022 Revista Medica del Instituto Mexicano del Seguro Social.
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Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC Randomized Clinical Trial.
JAMA2022 Jun;():. doi: 10.1001/jama.2022.9376.
Schlapbach Luregn J, Gibbons Kristen S, Horton Stephen B, Johnson Kerry, Long Debbie A, Buckley David H F, Erickson Simon, Festa Marino, d'Udekem Yves, Alphonso Nelson, Winlaw David S, Delzoppo Carmel, van Loon Kim, Jones Mark, Young Paul J, Butt Warwick, Schibler Andreas, ,
Abstract
Importance:
In children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation).
Objective:
To determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease.
Design, Setting, and Participants:
Double-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between July 2017 and April 2021, with 28-day follow-up of the last participant completed on May 24, 2021.
Interventions:
Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n?=?679) or standard care cardiopulmonary bypass without nitric oxide (n?=?685).
Main Outcomes and Measures:
The primary end point was the number of ventilator-free days from commencement of bypass until day 28. There were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the intensive care unit; length of stay in the hospital; and postoperative troponin levels.
Results:
Among 1371 patients who were randomized (mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%) completed the trial. The number of ventilator-free days did not differ significantly between the nitric oxide and standard care groups, with a median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2), respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to 0.22; P?=?.92). A total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28, for an adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary outcomes were not significantly different between the groups.
Conclusions and Relevance:
In children younger than 2 years undergoing cardiopulmonary bypass surgery for congenital heart disease, the use of nitric oxide via cardiopulmonary bypass did not significantly affect the number of ventilator-free days. These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery.
Trial Registration:
anzctr.org.au Identifier: ACTRN12617000821392.
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A cross-sectional Survey Study on Homophobia among Medical, Nursing, Pharmacy, and Other Health Sciences Students.
J Homosex2022 Jun;():1-17. doi: 10.1080/00918369.2022.2087480.
Harmanci Seren Arzu Kader, E?kin Bacaksiz Feride, Çakir Hanife, Yilmaz Sevil, Sükut Özge, Turan Suzan, Maghsoudi Nurten,
Abstract
Since the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community may be exposed to violence, discrimination, stigma, exclusion, and maltreatment due to their sexual orientation while accessing healthcare services, understanding, and improving the attitudes of future's health care professionals toward LGBTI individuals seem essential. This descriptive and cross-sectional study aimed to investigate the homophobia among medical, nursing, pharmacy, and healthcare sciences students and examine the related factors. The study included 2,531 students from medicine, nursing, pharmacy, and other health sciences (midwifery, nutrition and dietetics, physiotherapy, management of healthcare facilities) disciplines. Homophobia was measured with the Hudson and Ricketts Homophobia Scale. After getting ethical and institutional approvals, data were collected and analyzed using descriptive and inferential statistical tests. Medical students had the lowest homophobia score, and their mean score was significantly lower than other students. There was a significant difference between students' scores according to years of study, age, sex, acquaintance with LGBTI individuals, providing healthcare services to an LGBTI person, and opinions on providing care. Although homophobia scores of nursing, pharmacy, and other health sciences students were lower than the medical students', policies and expansive content regarding LGBTI should be in place in all health science educational institutes, including medical schools, to prevent students from holding homophobic and prejudicial attitudes against LGBTI individuals.
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Individualized prediction of risk of ascending aortic syndromes.
PLoS One2022 ;17(6):e0270585. doi: 10.1371/journal.pone.0270585.
Saleh Qais Waleed, Diederichsen Axel Cosmus Pyndt, Lindholt Jes Sanddal,
Abstract
OBJECTIVES:
Although ascending aortic diameter changes acutely after dissection, recommendation for prophylactic surgery of thoracic aortic aneurysms rely on data from dissected aortas. In this case-control study we aim to identify risk markers for acute and chronic aortic syndromes of the ascending aorta (ACAS-AA). Furthermore, to develop a predictive model for ACAS-AA.
METHODS:
We collected data of 188 cases of ACAS-AA and 376 controls standardized to age- and sex of the background population. Medical history and CT-derived aortic morphology were collected. For the dependent outcome ACAS-AA, potential independent risk factors were identified by univariate logistic regression and confirmed in multivariate logistic regression. As post-dissection tubular ascending aortic diameter is prone to expand, this factor was not included in the first model. The individual calculated adjusted odds ratios were then used in ROC-curve analysis to evaluate the diagnostic accuracy of the model. To test the influence of post-ACAS-AA tubular ascending aortic diameter, this was added to the model.
RESULTS:
The following risk factors were identified as independent risk factors for ACAS-AA in multivariate analysis: bicuspid aortic valve (OR 20.41, p = 0.03), renal insufficiency (OR 2.9, p
CONCLUSIONS:
A high performing predictive model for ACAS-AA, free of ascending aortic diameter, can be achieved. Furthermore, we have identified abdominal aortic ectasia as an independent risk factor of ACAS-AA. Integration of potential biomarkers and morphologic variables, derived from undissected aortas, would probably improve the model.
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Anti-Ca1.2 Antibody-Induced Atrioventricular Block as a Novel Form in the Adult: Long-Term Pacemaker-Sparing Activity of Hydroxychloroquine.
Circ Arrhythm Electrophysiol2022 Jun;():101161CIRCEP122011042. doi: 10.1161/CIRCEP.122.011042.
Lazzerini Pietro Enea, Salvini Viola, Srivastava Ujala, Ginjupalli Vamsi Krishna Murthy, Santoro Amato, Bertolozzi Iacopo, Accioli Riccardo, Laghi-Pasini Franco, Boutjdir Mohamed, Leopoldo Capecchi Pier,
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Whole Blood Selective Aortic Arch Perfusion for Exsanguination Cardiac Arrest: Assessing Myocardial Tolerance to the Duration of Cardiac Arrest.
Shock2022 Jun;57(6):243-250. doi: 10.1097/SHK.0000000000001946.
Madurska Marta J, Abdou Hossam, Elansary Noha N, Edwards Joseph, Patel Neerav, Stonko David P, Richmond Michael J, Scalea Thomas M, Rasmussen Todd E, Morrison Jonathan J,
Abstract
INTRODUCTION:
Selective aortic arch perfusion (SAAP) is an endovascular technique that consists of aortic occlusion with perfusion of the coronary and cerebral circulation. It been shown to facilitate return of spontaneous circulation (ROSC) after exanguination cardiac arrest (ECA), but it is not known how long arrest may last before the myocardium can no longer be durably recovered. The aim of this study is to assess the myocardial tolerance to exsanguination cardiac arrest before successful ROSC with SAAP.
METHODS:
Male adult swine (n?=?24) were anesthetized, instrumented, and hemorrhaged to arrest. Animals were randomized into three groups: 5, 10, and 15 min of cardiac arrest before resuscitation with SAAP. Following ROSC, animals were observed for 60 min in a critical care environment. Primary outcomes were ROSC, and survival at 1-h post-ROSC.
RESULTS:
Shorter cardiac arrest time was associated with higher ROSC rate and better 1-h survival. ROSC was obtained for 100% (8/8) of the 5-min ECA group, 75% (6/8) of the 10-min group, 43% (3/7) of the 15-min group (P?=?0.04). One-hour post-ROSC survival was 75%, 50%, and 14% in 5-, 10-, and 15-min groups, respectively (P?=?0.02). One-hour survivors in the 5-min group required less norepinephrine (1.31 mg?±?0.83?mg) compared with 10-SAAP (0.76 mg?±?0.24?mg), P?=?0.008.
CONCLUSION:
Whole blood SAAP can accomplish ROSC at high rates even after 10 min of unsupported cardiac arrest secondary to hemorrhage, with some viability beyond to 15 min. This is promising as a tool for ECA, but requires additional optimization and clinical trials.Animal Use Protocol, IACUC: 0919015.
Copyright © 2022 by the Shock Society.
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Trending ability of cardiac output measurements using electrical cardiometry during abdominal surgery: A cohort study.
Eur J Anaesthesiol2022 Jul;39(7):619-622. doi: 10.1097/EJA.0000000000001653.
Servaas Sjoerd, van Eijk Lucas T, Malagon Ignacio, Slagt Cornelis,
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Protective Effect of Cardiomyocyte-Specific Prolyl-4-Hydroxylase 2 Inhibition on Ischemic Injury in a Mouse MI Model.
J Am Coll Surg2022 Apr;():. doi: 10.1097/XCS.0000000000000241.
Pradeep Seetur R, Lim Sue Ting, Thirunavukkarasu Mahesh, Joshi Mandip, Cernuda Bryan, Palesty J Alexander, Maulik Nilanjana,
Abstract
BACKGROUND:
Our earlier studies showed that inhibiting prolyl-4-hydroxylase enzymes (PHD-1 and PHD-3) improves angiogenesis, heart function, and limb perfusion in mouse models via stabilizing hypoxia-inducible transcription factor-alpha (HIF-1?). The present study explored the effects of the prolyl-4-hydroxylase enzyme, PHD-2, on ischemic heart failure using cardiac-specific PHD-2 gene knockout (KO) mice (PHD2-/-).
STUDY DESIGN:
Adult wild-type (WT) and PHD2-/- mice, 8-12 weeks old, were subjected to myocardial infarction (MI) by irreversibly ligating the left anterior descending (LAD) coronary artery. All sham group mice underwent surgery without LAD ligation. Animals were divided into four groups 1) Wild-type Sham (WTS); Wild-Type myocardial infarction (WTMI); 3) PHD2KO Sham (PHD2-/-S); 4) PHD2KO myocardial infarction (PHD2-/-MI). Left ventricular tissue samples collected at various time points following surgery were used for microRNA expression profiling, Western blotting, immunohistochemical, and echocardiographic analysis.
RESULTS:
Volcano plot analysis revealed 19 differentially expressed miRNAs in the PHD2-/-MI compared to the WTMI group. Target analysis using Ingenuity Pathway Analysis showed several differentially regulated miRNAs targeting key signaling pathways such as Akt, VEGF, Ang-1, PTEN, apoptosis, and hypoxia pathways. Compared to the WTMI group, Western blot analysis showed increased HIF-1?, VEGF, phospho-AKT, and ?-catenin expression and reduced Bax expression for the PHD2-/-MI group post-MI. Echocardiographic analysis showed preserved heart functions, and picrosirius red staining revealed decreased fibrosis in PHD2-/-MI compared to the WTMI group.
CONCLUSION:
PHD2 inhibition showed preserved heart function, enhanced angiogenic factor expression, and decreased apoptotic markers after MI. Overall, PHD2 gene inhibition is a promising candidate for managing cardiovascular diseases.
Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
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Procurement and Decellularization of Rat Hindlimbs using an Ex Vivo Perfusion-based Bioreactor for Vascularized Composite Allotransplantation.
J Vis Exp2022 Jun;(184):. doi: 10.3791/64069.
Adil Aisha, Karoubi Golnaz, Haykal Siba,
Abstract
Patients with severe traumatic injuries and tissue loss require complex surgical reconstruction. Vascularized composite allotransplantation (VCA) is an evolving reconstructive avenue for transferring multiple tissues as a composite subunit. Despite the promising nature of VCA, the long-term immunosuppressive requirements are a significant limitation due to the increased risk of malignancies, end-organ toxicity, and opportunistic infections. Tissue engineering of acellular composite scaffolds is a potential alternative in reducing the need for immunosuppression. Herein, the procurement of a rat hindlimb and its subsequent decellularization using sodium dodecyl sulfate (SDS) is described. The procurement strategy presented is based upon the common femoral artery. A machine perfusion-based bioreactor system was constructed and used for ex vivo decellularization of the hindlimb. Successful perfusion decellularization was performed, resulting in a white translucent-like appearance of the hindlimb. An intact, perfusable, vascular network throughout the hindlimb was observed. Histological analyses showed the removal of nuclear contents and the preservation of tissue architecture across all tissue compartments.
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