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Pubblicazioni recenti - cardiac surgery
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Diagnostic accuracy of stroke volume variation for predicting fluid responsiveness in children undergoing cardiac surgery: a systematic review and meta-analysis.
Paediatr Anaesth2021 Apr;():. doi: 10.1111/pan.14195.
Luo Deqiang, Liu Fen, Dai Wei, Zhang Jianguo, Shao Qiang, Tao Wenqiang, Xiao Rui, Feng Xiaojin, Qian Kejian,
Abstract
BACKGROUND:
Stroke volume variation (SVV) appears to be reliable for predicting fluid responsiveness (FR) in adults and its predictive value in paediatric patients has been recently reported. However, its predictive value in children undergoing cardiac surgery is unclear.
METHODS:
A review and meta-analysis were performed on the diagnostic utility of SVV for predicting FR in children undergoing cardiac surgery. All relevant articles for prospective research assessing the value of SVV were searched in the Embase, MEDLINE (PubMed), and Cochrane databases through March 2020. The primary outcome was the accuracy of SVV for predicting FR in children. The combined data were analysed by a meta-analysis. Publication quality was assessed using the QUADAS (quality assessment for studies of diagnostic accuracy, maximum score) standard guidelines.
RESULTS:
Six articles were included in the meta-analysis, following the search strategy. A total of 251 children were included from 6 prospective studies. Fluid therapy for all patients used crystalloids or colloids. The results of the analysis revealed a pooled diagnostic odds ratio of 8.23 (95% CI: 3.07-22.11), pooled sensitivity of 0.73 (95% CI: 0.64-0.80), and pooled specificity of 0.66 (95% CI: 0.58-0.74). Additionally, the overall area of the summary receiver operating characteristic curve (SROC) was 0.78. There was significant moderate heterogeneity in these studies (p<0.05, I = 42.1%) due to thresholds.
CONCLUSIONS:
There was some heterogeneity due to thresholds in the included studies. An evaluation of SVV may represent a reliable predictor of FR in children undergoing cardiac surgery. After operative cardiac output optimization, the possible impact of goal-directed fluid treatment depending on SVV on the perioperative outcome in the children population should subsequently be assessed.
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Surgical Outcomes of Non-Small Cell Lung Cancer in Single-Zone N2 in the Aortopulmonary Zone.
Thorac Cardiovasc Surg2021 Apr;():. doi: 10.1055/s-0041-1727206.
Lee Kanghoon, Jeong Yong Ho, Ryu Jin-Sook, Kim Yong-Il, Kim Hyeong Ryul, Park Seung-Il,
Abstract
OBJECTIVES:
?We evaluate the surgical outcome of clinically single-zone N2 lung cancer limited to aortopulmonary zone (AP zone; lymph node #5 or #6).
PATIENTS AND METHODS:
?We performed a retrospective analysis of patients with non-small cell lung cancer, in whom mediastinal lymph node metastasis was confined to AP zone.
RESULTS:
?A total of 84 patients who underwent upfront surgery were included in final analysis. Among these patients, pathological nodal outcomes were pN0-1 in 27 patients (32.1%), pN2a in 31 (36.9%), and pN2b in 26 (31.0%). In multivariate analysis, adenocarcinoma (?=?0.005) and staging workup without endobronchial ultrasound-transbronchial needle aspiration (?=?0.002) were independent risk factors for unexpected pN2b. The 5-year overall survival (OS) and disease-free survival (DFS) were 55.9 and 54.4%, respectively. There was no survival difference among patients with pN0-1, pN2a, and pN2b (?=?0.717). In survival analysis, there were no significant risk factors for OS. However, female sex and the ratio of positive lymph nodes to removed lymph nodes were significant risk factors for DFS in multivariate analysis (?=?0.032 and ?=?0.009).
CONCLUSION:
?In this study, cN2a in the AP zone with current diagnostic tool exhibited a relatively high false-positive rate (cN2/pN0-1; 32.1%). However, despite the possibility of pN2b, there were no significant differences in survival outcome according to the pathologic nodal stage.
Thieme. All rights reserved.
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Heater-Cooler Devices and Risk of Contamination during Cardiac Surgery.
Thorac Cardiovasc Surg2021 Apr;():. doi: 10.1055/s-0040-1721745.
Kaluza Mirko, Färber Gloria, May Benjamin, Dobermann Ute, Pletz Mathias W, Edel Birgit, Löffler Bettina, Doenst Torsten,
Abstract
BACKGROUND:
?Heater-cooler devices (HCD) have been implicated in a cardiosurgical contamination scenario causing prosthetic valve endocarditis.
AIM:
?We characterized contamination of new HCDs and assessed the risk of intraoperative microorganism transmission from the HCD to the operating field.
METHODS:
?We initially acquired four new FlexTherm and then four new Maquet HCU40 HCDs and assessed occurrence and speed of microbial contamination (including mycobacteria) assessing swab and water samples from the device. In parallel, we collected repeated samples from different sites in the operating room either by swab sticks or by exposing different sample plates to room air. We also reviewed microbiological results from the hospital and compared them to cardiosurgical wound infections and endocarditis cases. Finally, we simulated cardiosurgical conditions and assessed the devices' ability to expel air to the operative field.
RESULTS:
?All new HCDs were clean before first use. Despite authority-mandated decontamination procedures, microbial growth (, , , , and ) was identified in all HCDs over time and could not be permanently eliminated. Four of these mircoorganisms were also found in tap water. However, none of the HCD-organisms were found inside the laminar airflow operating area. Importantly, except for , none of the HCD organisms were found in patients with surgical wound infections or endocarditis. HCD-expelled air did not rise more than 40?cm above ground.
CONCLUSION:
?HCDs cannot be expected to remain sterile despite extensive decontamination procedures. However, airborne transmission of microorganisms directly from the HCD to the operating field appears unlikely.
Thieme. All rights reserved.
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Telemedicine for adult congenital heart disease patients during the first wave of COVID-19 era: a single center experience.
J Cardiovasc Med (Hagerstown)2021 Apr;():. doi: 10.2459/JCM.0000000000001195.
Grandinetti Maria, Di Molfetta Arianna, Graziani Francesca, Delogu Angelica Bibiana, Lillo Rosa, Perri Gianluigi, Pavone Natalia, Bruno Piergiorgio, Aspromonte Nadia, Amodeo Antonio, Crea Filippo, Massetti Massimo,
Abstract
AIM:
To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of COVID-19.
METHODS:
This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination.
RESULTS:
A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab.
CONCLUSION:
During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.
Copyright © 2021 Italian Federation of Cardiology. All rights reserved.
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Broken heart syndrome during a weather storm: a case report in an oncological heart transplant recipient.
J Cardiovasc Med (Hagerstown)2021 Apr;():. doi: 10.2459/JCM.0000000000001198.
Bifulco Olimpia, Cavicchiolo Andrea Gualtiero, Lombardi Valentina, Toscano Giuseppe, Gerosa Gino,
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Memantine Alleviates Acute Lung Injury via Inhibiting Macrophage Pyroptosis.
Shock2021 Apr;():. doi: 10.1097/SHK.0000000000001790.
Ding Hongdou, Yang Jie, Chen Linsong, Li Yuehua, Jiang Gening, Fan Jie,
Abstract
ABSTRACT:
Acute lung injury (ALI) is caused by direct pulmonary insults and indirect systemic inflammatory responses that result from conditions such as sepsis and trauma. Alveolar macrophages are the main and critical leukocytes in the airspace, and through the synthesis and release of various inflammatory mediators critically influence the development of ALI following infection and non-infectious stimuli. There is increasing recognition that inflammation and cell death reciprocally affect each other, which forms an auto-amplification loop of these two factors, and in turn, exaggerates inflammation. Therefore, pharmacological manipulation of alveolar macrophage death signals may serve as a logical therapeutic strategy for ALI. In this study, we demonstrate that memantine, a N-methyl-D-aspartic acid receptor (NMDAR) antagonist, through suppressing Ca2+ influx and subsequent ASC oligomerization inhibits macrophage Nlrp3 inflammasome activation and pyroptosis, therefore, alleviates ALI in septic mice. This finding explores a novel application of memantine, an FDA already approved medication, in the treatment of ALI, which is currently lacking effective therapy.
Copyright © 2021 by the Shock Society.
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Fluid Responsiveness Predictability in Immediate Postoperative Pediatric Cardiac Surgery. Is the Old Slandered Central Venous Pressure Back Again?
Shock2021 Apr;():. doi: 10.1097/SHK.0000000000001786.
Shostak Eran, Shochat Tzippy, Manor Orit, Dagan Ovadia, Schiller Ofer,
Abstract
OBJECTIVE:
Acute low cardiac output (CO) is a frequent scenario in pediatric cardiac intensive care units (PCICU). While fluid responsiveness has been studied extensively, literature is scarce for the immediate postoperative congenital heart surgery population admitted to PCICUs. This study analyzed the utility of hemodynamic, bedside ultrasound and Doppler parameters for prediction of fluid responsiveness in infants and neonates in the immediate postoperative cardiac surgery period.
DESIGN:
A prospective observational study.
SETTING:
University affiliated, tertiary care hospital, PCICU.
PARTICIPANTS:
Immediate postoperative pediatric patients displaying a presumed hypovolemic low CO state were included. A clinical, arterial derived, hemodynamic, sonographic, Doppler-based, and echocardiographic parameter assessment was performed, followed by a fluid bolus therapy.
INTERVENTIONS:
15-20cc/kg Crystalloid fluid bolus.
MAIN OUTCOME MEASURES:
Fluid responsiveness was defined as an increase in cardiac index >?10% by echocardiography.
RESULTS:
Of 52 patients, 34 (65%) were fluid responsive. Arterial systolic pressure variation (SPV), continuous-Doppler preload parameters, and inferior vena-cava distensibility index (IVCDI) by bedside ultrasound all failed to predict fluid responsiveness. Dynamic central venous pressure (CVP) change yielded a significant but modest fluid responsiveness predictability of AUC 0.654 (p?=?0.0375).
CONCLUSIONS:
In a distinct population of mechanically ventilated, young, pediatric cardiac patients in the immediate postoperative period, SPV, USCOM preload parameters, as well as IVC-based parameters by bedside ultrasound failed to predict fluid responsiveness. Dynamic CVP change over several hours was the only parameter that yielded significant but modest fluid responsiveness predictability.
Copyright © 2021 by the Shock Society.
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circUBAP2 exacerbates malignant capabilities of NSCLC by targeting KLF4 through miR-3182 modulation.
Aging (Albany NY)2021 Mar;13():. doi: 10.18632/aging.202745.
Zheng Guanying, Huang Jianyuan, Chen Wenshu, You Peilin, Ding Yun, Tu Pengjie,
Abstract
Chemo-resistance and refractoriness remain challenges for Non-small cell lung cancer (NSCLC) patients and the underlying molecular mechanisms haven't been fully explained. In this study, we investigated the influence of circUBAP2 on the NSCLC tumor cells. This study might provide novel therapeutic targets for NSCLC treatment. Clinical samples and NSCLC cell lines were used to investigate circUBAP2 expressions and their impact on tumor cell chemo-resistance. CCK8 and transwell assays were conducted to explore the differences of NSCLC tumor proliferation and migration capabilities affected by circUBAP2. Dual-luciferase reporter gene assay was performed to explore the detailed molecular mechanism of circUBAP2 regulation network. circUBAP2 exhibited significantly elevated average level in our clinical samples of NSCLC, compared with normal tissues. CircUBAP2 level was positively correlated with disease stage and metastatic status. circUBAP2 significantly enhanced the migration, proliferation and chemo-resistance of NSCLC cell lines. Further experiments indicated that circUBAP2 promoted malignant biological behavior of NSCLC tumor cells by targeting KLF4 through modulating miR-3182 expression. Our study demonstrated for the first time that circUBAP2 played an important role exacerbating malignant capabilities of NSCLC. circUBAP2-miR3182-KLF4 regulative network demonstrated in this study could be a novel therapeutic target for future NSCLC treatment.
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Evaluation of disease staging and chemotherapeutic response in non-small cell lung cancer from patient tumor-derived metabolomic data.
Lung Cancer2021 Apr;156():20-30. doi: S0169-5002(21)00152-5.
Miller Hunter A, Yin Xinmin, Smith Susan A, Hu Xiaoling, Zhang Xiang, Yan Jun, Miller Donald M, van Berkel Victor H, Frieboes Hermann B,
Abstract
OBJECTIVES:
Despite extensive effort, the search for clinically-relevant metabolite biomarkers for early detection, disease monitoring, and outcome prediction in lung cancer remains unfulfilled. Although biofluid evaluation has been explored, the complexity inherent in metabolite data and the dynamic discrepancy between metabolites in biofluids vs. tumor tissue have prevented conclusive results. This proof-of-concept study explored models predictive of staging and chemotherapy response based on metabolomic analysis of fresh, patient-derived non-small cell lung cancer (NSCLC) core biopsies.
MATERIALS AND METHODS:
Samples (n?=?36) were evaluated with high-resolution 2DLC-MS/MS and C-glucose enrichment, and the data were comprehensively analyzed with machine learning techniques. Patients were categorized as Disease-Control (DC) [encompassing complete-response (CR), partial-response (PR), and stable-disease (SD)] and Progressive-Disease (PD) in terms of first-line chemotherapy. Four major types of learning methods (partial least squares discriminant analysis (PLS-DA), support vector machines (SVM), artificial neural networks, and random forests (RF)) were applied to differentiate between positive (DC and CR/PR) and poor (PD and SD/PD) responses, and between stage I/II/III and stage IV disease. Models were trained with forward feature selection based on variable importance and tested on validation subsets.
RESULTS:
The models predicted patient classifications in the validation subsets with AUC (95 % CI): DC vs. PD (SVM), 0.970(0.961-0.979); CR/PR vs. SD/PD (PLS-DA), 0.880(0.865-0.895); stage I/II/III vs. IV (SVM), 0.902(0.880-0.924). Highest performing model was SVM for DC vs. PD (balanced accuracy?=?0.92; kappa?=?0.74).
CONCLUSION:
This study illustrates a comprehensive evaluation of patient tumor-specific metabolic profiles, with the potential to identify disease stage and predict response to first-line chemotherapy.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Commentary: "POUR" the benefit of our patients.
Semin Thorac Cardiovasc Surg -
Impact of Postoperative Infections on Readmission and Resource Use in Elective Cardiac Surgery.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00705-0.
Hadaya Joseph, Downey Peter, Tran Zachary, Sanaiha Yas, Verma Arjun, Shemin Richard J, Benharash Peyman,
Abstract
BACKGROUND:
Efforts to reduce postoperative infections have garnered national attention, leading to practice guidelines for cardiac surgical perioperative care. The present study characterized the impact of healthcare-acquired infection (HAI) on index hospitalization costs and post-discharge healthcare utilization.
METHODS:
Adults undergoing elective coronary artery bypass grafting (CABG) and/or valve operations were identified in the 2016-2018 Nationwide Readmissions Database. Infections were categorized into bloodstream, gastrointestinal, pulmonary, surgical site, or urinary tract infections. Generalized linear or flexible hazard models were used to assess associations between infections and outcomes. Observed-to-expected (O/E) ratios were generated to examine inter-hospital variation in HAI.
RESULTS:
Of an estimated 444,165 patients, 8.0% developed HAI. Patients with HAI were older, had a greater burden of chronic diseases, and more commonly underwent CABG/valve or multi-valve operations (all p<0.001). HAI was independently associated with mortality (odds ratio 4.02, 95% CI 3.67-4.40), non-home discharge (3.48, 95% CI 3.21-3.78), and a cost increase of $23,000 (95% CI 20,900-25,200). At 90 days, HAI was associated with greater hazard of readmission (1.29, 95% CI 1.24-1.35). Pulmonary infections had the greatest incremental impact on patient-level ($24,500, 95% CI 23,100-26,00) and annual cohort costs ($121.8 million, 95% CI 102.2-142.9 million). Significant hospital level variation in HAI was evident, with O/E ranging from 0.17 to 4.3 for cases performed in 2018.
CONCLUSIONS:
Infections following cardiac surgery remain common and are associated with inferior outcomes and increased resource use. The presence of inter-hospital variation in this contemporary cohort emphasizes the ongoing need for systematic approaches in their prevention and management.
Copyright © 2021. Published by Elsevier Inc.
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Thoracic Surgery Foundation Research Awards: Leading the Way to Excellence.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00704-9.
Aranda-Michel Edgar, Arnaoutakis George, Kilic Arman, Bavaria Joseph, Szeto Wilson Y, Yousef Sarah, Navid Walter, Serna-Gallegos Derek, Sultan Ibrahim,
Abstract
BACKGROUND:
Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the NHLBI and NCI being 25.1% and 11.3% respectively. The Thoracic Surgery Foundation (TSF), which is an arm of the Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer reviewed funding. The aim of this study was to assess the impact of these awards.
METHODS:
Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed using SCOPUS , MEDLINE, and google scholar for publications, citations and h-index. NIH RePorter and federal RePorter was used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a four-year window from the time of the research award was utilized.
RESULTS:
Fifty-two research awards were given to early career faculty during this study period, 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty were awarded 27 (52%) of awards and general thoracic faculty were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period following the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range (IQR) 12-36) with a median citation count of 147 (IQR 32-327). The current median h-index was 26 (IQR 15-36) with 2,323 (IQR 1,173-4,568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant grant, with 40.4% being awarded from the NIH and25% having two or more NIH grants. Comparing academic position at the time of the award to current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors.
CONCLUSIONS:
Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.
Copyright © 2021. Published by Elsevier Inc.
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Multidisciplinary Virtual 3D Planning of a Forequarter Amputation with Chest Wall Resection.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00706-2.
Peek Jette J, Sadeghi Amir H, Maat Alexander P W M, Rothbarth Joost, Mureau Marc A M, Verhoef Cornelis, Bogers Ad J J C,
Abstract
We present a case of a 74-year-old male patient, with a history of a squamous cell carcinoma in the left axilla. The patient underwent a multidisciplinary surgical resection through an extended forequarter amputation with thoracic wall resection and reconstruction. With regard to the complexity of the case, 3D virtual reality-based patient-specific reconstructions were used as a supplemental tool to conventional computed tomography-imaging in order to plan the procedure. With this report, we aim to stimulate further research to improve and automate the workflow and to bring virtual and augmented reality reconstructions into the surgical theatre of the future.
Copyright © 2021. Published by Elsevier Inc.
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The Impact of Expedited Discharge on 30-Day Readmission Following Lung Resection: A National Study.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00701-3.
Tran Zachary, Chervu Nikhil, Williamson Catherine, Verma Arjun, Hadaya Joseph, Gandjian Matthew, Revels Sha'Shonda, Benharash Peyman,
Abstract
BACKGROUND:
Expedited discharge (within 24 hours) following lung resection has received scrutiny due to concerns for higher readmissions and paradoxically increased costs. The present study examined the impact of expedited discharge on hospitalization costs and unplanned readmissions using a nationally-representative sample. In addition, we sought to determine inter-hospital practice variation.
METHODS:
Adults undergoing elective lobar or sublobar resection were identified using the 2016-2018 Nationwide Readmissions Database, while those with postoperative duration of hospitalization >5 days or experienced any perioperative complication, were excluded. Patients were classified as Expedited if postoperative hospitalization was 0 or 1 day and otherwise as Routine. Inverse probability of treatment weighing was utilized to adjust for intergroup differences. Hospitals were ranked according to risk-adjusted early discharge rates. Multivariable regression models were developed to assess the association of expedited discharge on nonelective 30-day readmissions as well as associated mortality and costs.
RESULTS:
Of an estimated 84,152 patients, 13,834 (16.4%) comprised the Expedited group. Compared to Routine, Expedited were younger, less likely to have chronic obstructive pulmonary disease and undergo open procedures. Following adjustment, early discharge was associated with lower incremental costs (? coefficient: -$3.6K, 95%CI: -4.4 - -2.8) as well as similar readmissions (odds ratio: 0.89, 95%CI: 0.70 - 1.13) and related-mortality. Nearly half (48.1%) of all hospitals performed zero early discharges.
CONCLUSIONS:
Expedited discharge following lung resection is a feasible management strategy and is associated with decreased costs and similar readmission risk compared to the norm. Select individuals should be strongly considered for expedited discharge following lung resection.
Copyright © 2021. Published by Elsevier Inc.
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Surgical and percutaneous management of aboriginal Australians with rheumatic heart disease: Timeliness and concordance between practice and guidelines.
Int J Cardiol2021 Apr;():. doi: S0167-5273(21)00666-5.
Roberts-Thomson Ross L, Baumann Angus, Reade Julie, Culgan Libby, Kaethner Alex, Ilton Marcus, Kangaharan Nadarajah, Tayeb Hussam, Sinhal Ajay, Chew Derek, Bennetts Jayme, Nicholls Stephen J, Psaltis Peter J, Brown Alex,
Abstract
BACKGROUND:
Rheumatic heart disease (RHD) affects over 40 million people globally who are predominantly young and from impoverished communities. The barriers to valvular intervention are complex and contribute to the high morbidity and mortality associated with RHD. The rates of guideline indicated intervention in patients with significant RHD have not yet been reported.
METHODS:
From 2007 to 2017, we used the Australian Northern Territory Cardiac Database to identify patients with RHD who fulfilled at least one ESC/EACTS guideline indication for mitral valve intervention. Baseline clinical status, comorbidities, echocardiographic parameters, indication for intervention, referral and any interventions were recorded.
RESULTS:
154 patients (mean age 38.5 ± 14.6, 66.1% female) were identified as having a class I or IIa indication for invasive management. Symptoms, atrial fibrillation and pulmonary hypertension were the most common indications for surgery (74.5%, 48.1%, 40.9%). From the onset of a guideline indication the actuarial rates of accepted referral and intervention within two-years were 66.0%?±?4.0% and 53.1%?±?4.4% respectively. Of those who were referred and accepted for intervention, 86% received it within 2?years. The rates of accepted referral for patients with class I indications were 72.5% ± 4.2% while class IIa indications were 42.5% ± 9.0% (p?
CONCLUSIONS:
Approximately half of Aboriginal patients with significant rheumatic mitral valve disease who met ESC/EACTS guideline indications for intervention received surgery or valvuloplasty within two-years. A significant difference in referral rates was found between Class I and Class IIa indications for valvular intervention.
Copyright © 2021. Published by Elsevier B.V.
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A Biphasic Osteovascular Biomimetic Scaffold for Rapid and Self-Sustained Endochondral Ossification.
Adv Healthc Mater2021 Apr;():e2100070. doi: 10.1002/adhm.202100070.
Kim Hwan D, Hong Xuechong, An Young-Hyeon, Park Mihn Jeong, Kim Do-Gyoon, Greene Arin K, Padwa Bonnie L, Hwang Nathaniel S, Lin Ruei-Zeng, Melero-Martin Juan M,
Abstract
Regeneration of large bones remains a challenge in surgery. Recent developmental engineering efforts aim to recapitulate endochondral ossification (EO), a critical step in bone formation. However, this process entails the condensation of mesenchymal stem cells (MSCs) into cartilaginous templates, which requires long-term cultures and is challenging to scale up. Here, a biomimetic scaffold is developed that allows rapid and self-sustained EO without initial hypertrophic chondrogenesis. The design comprises a porous chondroitin sulfate cryogel decorated with whitlockite calcium phosphate nanoparticles, and a soft hydrogel occupying the porous space. This composite scaffold enables human endothelial colony-forming cells (ECFCs) and MSCs to rapidly assemble into osteovascular niches in immunodeficient mice. These niches contain ECFC-lined blood vessels and perivascular MSCs that differentiate into RUNX2 OSX pre-osteoblasts after one week in vivo. Subsequently, multiple ossification centers are formed, leading to de novo bone tissue formation by eight weeks, including mature human OCN OPN osteoblasts, collagen-rich mineralized extracellular matrix, hydroxyapatite, osteoclast activity, and gradual mechanical competence. The early establishment of blood vessels is essential, and grafts that do not contain ECFCs fail to produce osteovascular niches and ossification centers. The findings suggest a novel bioengineering approach to recapitulate EO in the context of human bone regeneration.
© 2021 Wiley-VCH GmbH.
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Not All Gymnastic Exercises Are Suitable for Everyone: An Uncommon Cause of Thoracic Outlet Syndrome: A Case Report.
JBJS Case Connect2021 Apr;11(2):. doi: e20.00984.
Wong Yat Wah, Wong Douglas K H, Cheng Stephen W K,
Abstract
CASE:
A 34-year-old man spontaneously presented with bilateral thoracic outlet syndrome over 1 year. He was a gymnast active in rowing and weightlifting, with "slanted" shoulders, narrowed costoclavicular spaces, and well-developed scalene muscles. Imaging revealed fractures of multiple bilateral upper ribs in various degrees of nonunion. The patient's symptoms improved after activity modification and physiotherapy.
CONCLUSIONS:
Atraumatic spontaneous rib fracture-nonunions are an uncommon cause of thoracic outlet syndrome; this diagnosis should be considered in physically active patients presenting with typical symptoms with atypical anatomy.
Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.
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Association of carotid ultrasonography with perioperative stroke after thoracic aortic aneurysm treatment: a retrospective study.
J Med Ultrason (2001)2021 Apr;():. doi: 10.1007/s10396-021-01096-0.
Ito Michiko, Shimada Hirofumi, Ogata Toshiyasu, Teratani Hiromitsu, Tsuboi Yoshio, Inoue Tooru, Wada Hideichi,
Abstract
PURPOSE:
The purpose of this study was to verify whether carotid ultrasonography (CUS) findings could be associated with the occurrence of perioperative stroke after thoracic aortic aneurysm (TAA) treatment.
METHODS:
Patients with TAAs who were treated by either total arch replacement or thoracic endovascular aortic repair (TEVAR) were retrospectively enrolled. Left subclavian artery (LSA) embolization and bypass surgery of the left common carotid artery (CCA) to the LSA before TEVAR were additionally performed for some patients. CUS was performed before TAA treatment to evaluate carotid atherosclerosis and flow velocities of bilateral cervical arteries. After dividing patients into those with and without perioperative stroke, their background, atherosclerotic risk factors, history of stroke, TAA location and size, treatment procedures, and CUS parameters were compared between the two groups.
RESULTS:
Of the 60 patients (18 women, 42 men; mean age 73.5?±?10.2 years) with TAA, four (7.5%) developed perioperative stroke. There were no significant differences in the patients' characteristics and their TAAs between those with and without perioperative stroke. For the CUS parameters, end-diastolic velocity (EDV) of bilateral CCAs was significantly decreased in perioperative stroke patients (with vs without stroke; right: 9.2?±?1.8 vs. 14.5?±?4.6 cm/s, P?=?0.025, left: 9.1?±?0.3 vs. 15.0?±?4.5 cm/s, P?=?0.012), whereas the resistance index (RI) of bilateral CCAs was significantly elevated (right: 0.76 vs. 0.87, P?=?0.008, left: 0.76 vs. 0.87, P?
CONCLUSIONS:
Lower EDV and higher RI of bilateral CCAs were significantly associated with perioperative stroke after TAA treatment. Thus, CUS findings may help predict the occurrence of perioperative stroke.
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Outcome of thoracoscopic anatomical sublobar resection under 3-dimensional computed tomography simulation.
Surg Endosc2021 Apr;():. doi: 10.1007/s00464-021-08506-x.
Hamada Akira, Oizumi Hiroyuki, Kato Hirohisa, Suzuki Jun, Nakahashi Kenta, Takamori Satoshi, Sho Ri, Sadahiro Mitsuaki,
Abstract
BACKGROUND:
Previous studies have reported the feasibility and efficacy of thoracoscopic anatomical sublobar resection under three-dimensional computed tomography (3DCT) simulation; however, its long-term outcomes have not been clearly established in primary lung cancer. This study aimed to evaluate the long-term outcomes of this technique.
METHODS:
We retrospectively reviewed data from 112 consecutive patients with selected clinical stage IA non-small cell lung cancer (NSCLC) who underwent thoracoscopic anatomical sublobar resection from 2004 to 2014. This procedure was planned using preoperative 3DCT simulation to ensure sufficient surgical margins and enabled tailor-made surgery for each patient. Patients who had predominantly ground glass opacity lung cancers underwent anatomical sublobar resection as a curative-intent resection. Other patients who were high-risk candidates for lobectomy underwent anatomical sublobar resection as a compromised limited resection.
RESULTS:
Of the 112 cases, 82 had a curative-intent resection, while 30 had a compromised limited resection. Recurrence occurred in only 2 cases (1.8%), both of which were in the compromised limited group. A second primary lung cancer was observed in 5 cases (4.5%). Of the 5 patients, 4 underwent surgery for a second cancer and had no recurrence. The 5-year overall survival, lung cancer-specific overall survival, and recurrence-free survival rates were 92.5%, 100%, and 98.2%, respectively, for all cases; 97.6%, 100%, and 100%, respectively, in the curative-intent group; and 75.8%, 100% and 92.6%, respectively, in the compromised limited group.
CONCLUSIONS:
Thoracoscopic anatomical sublobar resection under 3DCT simulation may be an acceptable alternative treatment in selected patients with NSCLC.
TRIAL AND CLINICAL REGISTRY:
Clinical registration number: IRB No. 2020-98 (Dated: 2020.6.30).
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Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates.
Pediatr Cardiol2021 Apr;():. doi: 10.1007/s00246-021-02619-9.
Ozawa Hideto, Hoashi Takaya, Ohuchi Hideo, Kurosaki Kenichi, Ichikawa Hajime,
Abstract
The study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were excluded. In fenestration group, patients with pre-Fontan mean pulmonary arterial pressure???15 mmHg or systemic atrioventricular valve regurgitation???moderate were classified as high-risk Fontan candidates (F-HR group, n?=?16), and the remaining patients were as standard-risk (F-SR group, n?=?12). Protein-losing enteropathy-free survival rates did not differ among the three groups (p?=?0.72). Serial follow-up catheter examinations after Fontan operation were completed in 69 patients in NF group and 11 patients in both F-SR and F-HR groups. Cardiac index and pulmonary vascular resistance significantly and similarly decreased over time in all groups, though the F-HR group showed lowest arterial oxygen saturation, lowest cardiac index, and highest pulmonary vascular resistance. The F-HR group also showed much veno-venous collaterals (p?=?0.049), low peak oxygen consumption (p?=?0.019), and low anaerobic threshold (p?=?0.023) as compared to those in the F-SR group. In F-HR group, cyanosis remained after fenestration closure due to transformation from fenestration to veno-venous collaterals, which resulted in elevation of pulmonary vascular resistance, low cardiac index, and deterioration of exercise tolerance.
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