scholarly journals Expert Opinions on the Debate of Pericardial Reconstruction in Cardiovascular Surgery: To Close or Not to Close?

2022 ◽  
Vol 25 (1) ◽  
pp. E008-E019
Author(s):  
Alfredo Rego ◽  
W. Douglas Boyd ◽  
Enrique Gongora ◽  
William E. Johnson, III ◽  
Nabil A. Munfakh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Expert Opinion ◽  
Length Of Hospital Stay ◽  
Surgical Experience ◽  
Future Studies ◽  
Expert Opinions ◽  
Evidence Quality ◽  
Specific Tissue ◽  
Consensus Expert

Background: As of 2019, pericardial closure was performed in only a small portion of the over 320,000 cardiac surgeries performed annually. However, evidence regarding the benefits of pericardial closure or reconstruction has been accruing, particularly with the publication of the RECON study in 2019.  Methods: This group of authors convened to try to arrive at consensus expert opinion regarding pericardial reconstruction. Structured topic questions initially were used to stimulate discussion. Subsequently, a survey of proposed expert opinion statements was conducted among the authors. Based on that survey, consensus expert opinion statements and recommendations were compiled. Results: The expert opinions encompass various topics relating to pericardial reconstruction, including definitions, benefits/risks, and technique. Observed benefits include reductions in: (1) adhesions; (2) postoperative pericardial effusion, atrial fibrillation, and bleeding; and (3) readmissions and length of hospital stay. Expert opinion recommendations regarding surgical technique are compiled into a single chart. Complete pericardial reconstruction should be performed, using native pericardial tissue if available and viable; if not feasible, a patch may be used. Patches that stimulate the formation of site-specific tissue in situ (such as natural extracellular matrix) may have additional benefits (including bioregenerative properties and lack of inflammatory response). Closure should be taut, but tension-free. Adequate drainage of the closed pericardium must be ensured. Conclusions: Based on available data and collective surgical experience, we endorse pericardial reconstruction as standard approach in appropriately selected patients. We also endorse adoption of standardized pericardial reconstruction techniques to optimize patient outcomes and improve evidence quality in future studies.

ALTERNATIVE COEFFICIENT OF CONCORDANCE IN CASE OF CONNECTED RANKS

2021 ◽  
pp. 40-45
Author(s):  
Ю.В. Лубенец
Keyword(s):  
Expert Opinion ◽  
Special Kind ◽  
Statistical Characteristics ◽  
Expert Survey ◽  
Complete Consistency ◽  
Expert Opinions ◽  
Coefficient Of Concordance ◽  
Definition Of ◽  
Two Stages ◽  
Good Agreement

Рассматривается оценка согласованности мнений экспертов при проведении экспертного опроса. Наиболее часто в качестве такой оценки применяется коэффициент конкордации Кендалла. Однако этот коэффициент не может в полной мере применяться для установления хорошей согласованности мнений экспертов, поскольку он показывает только отклонение от случаев полной несогласованности. Для устранения данного недостатка может рассматриваться альтернативный коэффициент конкордации, оценивающий близость сумм рангов альтернатив к случаю полной согласованности. Здесь дается определение этого коэффициента при наличии связанных рангов. Сложность определения заключается в том, что в этом случае наблюдается несколько случаев полной согласованности с различными суммами рангов. Определение альтернативного коэффициента конкордации при наличии связанных рангов проводится в два этапа. Сначала вводится его определение для упорядоченных таблиц специального вида и показывается его совпадение с коэффициентом конкордации Кендалла в этом случае. После дается определение альтернативного коэффициента конкордации в общем случае и показывается более простая формула его вычисления. Далее приводятся некоторые примеры сравнений значений рассматриваемых коэффициентов конкордации, их статистических характеристик и гистограмм The article considers evaluation of expert opinion consistency when conducting an expert survey. The most commonly used score is Kendall's coefficient of concordance. However, this coefficient cannot be fully applied to establish good agreement of expert opinions, as it only shows deviations from cases of complete inconsistency. To eliminate this drawback, an alternative concordance coefficient can be considered, which estimates the proximity of the sums of the ranks of the alternatives to the case of complete consistency. The article gives the definition of this coefficient in the presence of connected ranks. The difficulty of this definition lies in the fact that in this case there are several cases of complete consistency with different sums of ranks. Definition of the alternative coefficient of concordance in the presence of tied ranks is carried out in two stages. First, its definition for ordered tables of a special kind is introduced and its coincidence with Kendall's coefficient of concordance in this case is shown. After that, the definition of the alternative coefficient of concordance in the general case is given and a simpler formula for its calculation is shown. Below are some examples of comparisons of the values of the considered concordance coefficients, their statistical characteristics, and histograms

The cell adhesion molecule M-cadherin is specifically expressed in developing and regenerating, but not denervated skeletal muscle

Development ◽  
1993 ◽  
Vol 117 (4) ◽  
pp. 1409-1420 ◽  
Author(s):  
R. Moore ◽  
F.S. Walsh
Keyword(s):  
Skeletal Muscle ◽  
Tissue Distribution ◽  
Cell Adhesion Molecule ◽  
Muscle Denervation ◽  
Regulatory Factor ◽  
Myogenic Regulatory Factor ◽  
Adult Skeletal Muscle ◽  
Specific Tissue ◽  
Alpha Actin

The spatiotemporal distribution of M-cadherin mRNA has been determined by in situ hybridization in the mouse embryo and in adult skeletal muscle following experimental regeneration and denervation. M-cadherin mRNA is highly tissue specific and is found only in developing skeletal muscle. In contrast, N-cadherin mRNA has a broader tissue distribution in the embryo, being found on both neural elements and skeletal and cardiac muscle. M-cadherin is expressed in the myotomes shortly after they form, along with the myogenic regulatory factor myogenin. M-cadherin is expressed in muscles derived from the myotomes and is detected in forelimb bud precursor cells at embryonic day 11.5. In the latter case M-cadherin expression appears co-ordinately with that of myogenin and cardiac alpha-actin. Shortly before birth, M-cadherin expression is down regulated. M-cadherin can, however, be re-expressed following experimental regeneration of skeletal muscle. Here M-cadherin is transiently expressed on regenerating myoblasts but not myotubes. Following muscle denervation no evidence was found for re-expression of M-cadherin under conditions where there was strong expression of the nicotinic acetylcholine receptor on myofibres. The highly specific tissue distribution and unique developmental profile distinguishes M-cadherin from other cadherins and suggests a role in cell surface events during early myogenesis.

scholarly journals Autofluorescence Is a Common Trait in Different Oceanic Fungi

2021 ◽  
Vol 7 (9) ◽  
pp. 709
Author(s):  
Eva Breyer ◽  
Markus Böhm ◽  
Magdalena Reitbauer ◽  
Chie Amano ◽  
Marilena Heitger ◽  
...  
Keyword(s):  
Marine Fungi ◽  
Physiological State ◽  
Excitation Wavelength ◽  
Growth Stages ◽  
Future Studies ◽  
Different Types ◽  
Widespread Phenomenon ◽  
Ubiquitous Presence ◽  
Different Growth Stages

Natural autofluorescence is a widespread phenomenon observed in different types of tissues and organisms. Depending on the origin of the autofluorescence, its intensity can provide insights on the physiological state of an organism. Fungal autofluorescence has been reported in terrestrial and human-derived fungal samples. Yet, despite the recently reported ubiquitous presence and importance of marine fungi in the ocean, the autofluorescence of pelagic fungi has never been examined. Here, we investigated the existence and intensity of autofluorescence in five different pelagic fungal isolates. Preliminary experiments of fungal autofluorescence at different growth stages and nutrient conditions were conducted, reflecting contrasting physiological states of the fungi. In addition, we analysed the effect of natural autofluorescence on co-staining with DAPI. We found that all the marine pelagic fungi that were studied exhibited autofluorescence. The intensity of fungal autofluorescence changed depending on the species and the excitation wavelength used. Furthermore, fungal autofluorescence varied depending on the growth stage and on the concentration of available nutrients. Collectively, our results indicate that marine fungi can be auto-fluorescent, although its intensity depends on the species and growth condition. Hence, oceanic fungal autofluorescence should be considered in future studies when fungal samples are stained with fluorescent probes (i.e., fluorescence in situ hybridization) since this could lead to misinterpretation of results.

Coordinate amplification of metallothionein I and II genes in cadmium-resistant Chinese hamster cells: implications for mechanisms regulating metallothionein gene expression

1985 ◽  
Vol 5 (2) ◽  
pp. 320-329
Author(s):  
B D Crawford ◽  
M D Enger ◽  
B B Griffith ◽  
J K Griffith ◽  
J L Hanners ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Polyacrylamide Gel Electrophoresis ◽  
Chinese Hamster ◽  
Chinese Hamster Cell ◽  
Chinese Hamster Cells ◽  
Future Studies ◽  
Noncoding Regions ◽  
Genes Encoding ◽  
Chinese Hamster Cell Line

We describe here the derivation, characterization, and use of clonal cadmium-resistant (Cdr) strains of the Chinese hamster cell line CHO which differ in their metallothionein (MT) induction capacity. By nondenaturing polyacrylamide gel electrophoresis, we showed that the stable Cdr phenotype is correlated with the augmented expression of both isometallothioneins (MTI and MTII). In cells resistant to concentrations of CdCl2 exceeding 20 microM, coordinate amplification of genes encoding both isometallothioneins was demonstrated by using cDNA MT-coding sequence probes and probes specific for 3'-noncoding regions of Chinese hamster MTI and MTII genes. Molecular and in situ hybridization analyses supported close linkage of Chinese hamster MTI and MTII genes, which we have mapped previously to Chinese hamster chromosome 3. This suggests the existence of a functionally related MT gene cluster in this species. Amplified Cdr variants expressing abundant MT and their corresponding Cds parental CHO cells should be useful for future studies directed toward elucidating the mechanisms that regulate expression of the isometallothioneins.

Relocation of phosphofructokinases within epithelial cells is a novel event preceding breast cancer recurrence that accurately predicts patient outcomes

2021 ◽  
Author(s):  
Richard A. Cheung ◽  
Alexandra M. Kraft ◽  
Howard R. Petty
Keyword(s):  
Epithelial Cells ◽  
Patient Outcomes ◽  
Glucose Transporter ◽  
Ductal Carcinoma ◽  
Cancer Recurrence ◽  
Recurrence Risk ◽  
Apical Surface ◽  
Ductal Epithelial Cell ◽  
Glucose Transporter 1

Although recurrent cancers are often aggressive, little is known about the intracellular events required for cancer recurrences. Due to this lack of mechanistic information, there is no test to predict cancer recurrences or non-recurrences during early stages of disease. In this retrospective study, we use ductal carcinoma in situ (DCIS) of the breast as a framework to better understand the mechanism of cancer recurrences using patient outcomes as the physiological observable. Conventional pathology slides were labeled with anti-phosphofructokinase type L (PFKL) and anti-phosphofructokinase/fructose-2,6-bisphosphatase type 4 (PFKFB4) reagents. PFKL and PFKFB4 were found in ductal epithelial cell nucleoli from DCIS samples of women who did not experience a cancer recurrence. In contrast, PFKL and PFKFB4 may be found near the plasma membrane in samples from patients who will develop recurrent cancer. Using machine learning to predict patient outcomes, holdout studies of individual patient micrographs for the three biomarkers PFKL, PFKFB4, and phosphorylated GLUT1 demonstrated 38.6% true negatives, 49.5% true positives, 11.9% false positives and 0% false negatives (N=101). A sub-population of recurrent samples demonstrated PFKL, PFKFB4, and phosphorylated glucose transporter 1 accumulation at the apical surface of epithelial cells, suggesting that carbohydrates can be harvested from the ducts' luminal spaces as an energy source. We suggest that PFK isotype patterns are metabolic switches representing key mechanistic steps of recurrences. Furthermore, PFK enzyme patterns within epithelial cells contribute to an accurate diagnostic test to classify DCIS patients as high or low recurrence risk.

scholarly journals Outcome Difference in Neurosurgical Patients Based on Timing of Tracheostomy and Ventilator Associated Pneumonia

2018 ◽  
Vol 15 (1) ◽  
pp. 19-22
Author(s):  
Pratyush Shrestha ◽  
Subash Lohani ◽  
Sunita Shrestha ◽  
Upendra P Devkota
Keyword(s):  
Hospital Stay ◽  
Tracheostomy Tube ◽  
Length Of Hospital Stay ◽  
Ventilator Associated Pneumonia ◽  
Early Tracheostomy ◽  
Icu Stay ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
Length Of Icu Stay

Background and Objective: Tracheostomy in neurosurgical patients has been shown in various studies to lower the length of ICU stay and the length of hospital stay by decreasing the incidence of ventilator associated pneumonia. In this regard, we wanted to evaluate the outcome of neurosurgical ICU patients based on timing of tracheostomy and ventilator associated pneumonia.Methods: This is a retrospective single centre study performed over a period of two and a half years. Early tracheostomy was defi ned as those done three days of intubation or earlier and late as those done then after. Statistical analysis was done using SPSS.Results: There were 56 patients over the study period of which 18 patients underwent early tracheostomy and 38 patients underwent late tracheostomy. There was no statistically significant difference between the two groups with regards to the length of ICU stay, the length of hospital stay or the length of tracheostomy tube in situ. But based on tracheal aspirate culture positivity, length of tracheostomy tube in situ was signifi cantly longer in those with positive bacterial cultures.Early tracheostomy does not improve neurosurgical outcome while documented pneumonia prolongs the length of tracheostomy tube in situ.Nepal Journal of Neuroscience 15:19-22, 2018

Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study

2018 ◽  
Vol 4 (4) ◽  
pp. 190-195 ◽  
Author(s):  
Owain Michael Leng ◽  
Charlotte Rothwell ◽  
Annamarie Buckton ◽  
Catherine Elmer ◽  
Jan Illing ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Simulation Education ◽  
Audit Data ◽  
Semistructured Interviews ◽  
The Impact

BackgroundThe patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes.ObjectiveTo evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital.MethodsThis study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention.ResultsThe in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia.ConclusionThis study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.

scholarly journals Impact of Having a Planned Additional Operation at Time of Liver Transplant on Graft and Patient Outcomes

2020 ◽  
Vol 9 (2) ◽  
pp. 608
Author(s):  
Shirin Salimi ◽  
Keval Pandya ◽  
Vinay Sastry ◽  
Claire West ◽  
Susan Virtue ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Liver Graft ◽  
Short Term ◽  
Additional Operation ◽  
Additional Surgery ◽  
Surgical Complexity ◽  
Abdominal Operations ◽  
Baseline Characteristics

Advances in liver transplantation (LT) have allowed for expanded indications and increased surgical complexity. In select cases, additional surgery may be performed at time of LT rather than prior to LT due to the significant risks associated with advanced liver disease. We retrospectively studied the characteristics and outcomes of patients who underwent an additional planned abdominal or cardiac operation at time of LT between 2011–2019. An additional operation (LT+) was defined as a planned operation performed under the same anesthetic as the LT but not directly related to the LT. In total, 547 patients were included in the study, of which 20 underwent LT+ (4%). Additional operations included 10 gastrointestinal, 5 splenic, 3 cardiac, and 2 other abdominal operations. Baseline characteristics between LT and LT+ groups were similar. The median total operating time was significantly longer in LT+ compared to LT only (451 vs. 355 min, p = 0.002). Graft and patient survival, intraoperative blood loss, transfusion of blood products, length of hospital stay, and post-operative complications were not significantly different between groups. In carefully selected patients undergoing LT, certain additional operations performed at the same time appear to be safe with equivalent short-term outcomes and liver graft survival as those undergoing LT alone

scholarly journals Safety of patients and providers in lung cancer surgery during the COVID-19 pandemic

2020 ◽  
Vol 58 (6) ◽  
pp. 1222-1227
Author(s):  
Stephanie H Chang ◽  
Michael Zervos ◽  
Amie Kent ◽  
Abraham Chachoua ◽  
Costas Bizekis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
New York ◽  
New York City ◽  
Patient Outcomes ◽  
Pulmonary Resection ◽  
Lung Cancer Surgery ◽  
Length Of Hospital Stay ◽  
Major Morbidity ◽  
Hospital Capacity ◽  
Surgical Assistants

Abstract OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection—13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.

scholarly journals A Penetrometer for Quantifying the Surface Stiffness of Sport Sand Surfaces

Proceedings ◽  
2020 ◽  
Vol 49 (1) ◽  
pp. 64 ◽  
Author(s):  
David V. Thiel ◽  
Matthew T. O. Worsey ◽  
Florian Klodzinski ◽  
Nicholas Emerson ◽  
Hugo G. Espinosa
Keyword(s):  
Soft Tissue Injuries ◽  
Beach Sand ◽  
Depth Of Penetration ◽  
Future Studies ◽  
Novel Technique ◽  
Sand Box ◽  
Surface Stiffness ◽  
Fitness Training ◽  
The Relationship

Sand sports include running, volleyball, soccer, beach flags, ironman, and fitness training. An increased amount of soft tissue injuries have been widely reported. A novel technique of determining the surface stiffness of beach sand in-situ used a simple drop-test penetrometer. The relationship between drop height and the depth of penetration squared was linear (Pearson’s correlation coefficient r2 > 0.92). The stiffness ratio between the soft dry sand and ocean-saturated wet sand compacted by eight hours of coastal water exposure was approximately seven, which was similar to previously reported stiffness measurements in a sand box. However, the absolute stiffness values were much smaller. While this technique was manually operated, an automatic system is postulated for future studies.

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