Surgical left ventricle restoration (SVR) was firstly by Cooley in 1958 with the “linear suture technique”, and three decades later, Dor used a circular patch to reconstruct the left ventricle excluding the scarred parts of the septum and ventricular wall. It gained popularity and eventually almost abandoned after the contrasting literature evidences. Hassanabad et al. presented a comprehensive review of current literature on surgical ventricle restoration (SVR) techniques and clinical outcomes, trying to understand if SVR has still a substantial role in the modern medicine.
Lesions involving the tongue may present with life threatening complications such as airway compromise and risk of severe hemorrhage. This paper reports the surgical management of a non-involuting massive congenital hemangioma of the tongue in an infant presenting with difficulty breathing, feeding and inability to close the mouth.
Since the introduction of the saphenous vein graft (SVG) for coronary artery bypass grafting (CABG) in 1962, the SVG has remained the most commonly used conduit to the non-LAD territories for more than half a century. However, several issues surrounding the use of SVGs, including higher graft occlusion rates and wound complications from the harvesting process, have been identified in clinical practice. As such, significant interest has been dedicated towards developing harvesting techniques that minimize the risk of these acute and late complications. In this issue of the Journal of Cardiac Surgery, Yokoyama and colleagues compared the impact of open vein harvesting (OVH), endoscopic vein harvesting (EVH) and no-touch vein harvesting (NT) on all-cause mortality, revascularization and graft failure, using a network meta-analysis based on randomized controlled trials and propensity-score matched studies. The results showed that the risk of graft failure was approximately halved amongst patients receiving NT compared with EVH and OVH; importantly, though, NT was not associated with lower all-cause mortality or revascularization risk. To further examine whether the use of NT grafts endow patients with better long-term clinical outcomes, such as mortality, myocardial infarction, and revascularization rates, a large-scaled randomized controlled trial or a patient-level combined meta-analysis is required.
Sparse (fast) representations of deterministic signals have been well studied. Among other types there exists one called adaptive Fourier decomposition (AFD) for functions in analytic Hardy spaces. Through the Hardy space decomposition of the $L^2$ space the AFD algorithm also gives rise to sparse representations of signals of finite energy. To deal with multivariate signals the general Hilbert space context comes into play. The multivariate counterpart of AFD in general Hilbert spaces with a dictionary has been named pre-orthogonal AFD (POAFD). In the present study we generalize AFD and POAFD to random analytic signals through formulating stochastic analytic Hardy spaces and stochastic Hilbert spaces. To analyze random analytic signals we work on two models, both being called stochastic AFD, or SAFD in brief. The two models are respectively made for (i) those expressible as the sum of a deterministic signal and an error term (SAFDI); and for (ii) those from different sources obeying certain distributive law (SAFDII). In the later part of the paper we drop off the analyticity assumption and generalize the SAFDI and SAFDII to what we call stochastic Hilbert spaces with a dictionary. The generalized methods are named as stochastic pre-orthogonal adaptive Fourier decompositions, SPOAFDI and SPOAFDII. Like AFDs and POAFDs for deterministic signals, the developed stochastic POAFD algorithms offer powerful tools to approximate and thus to analyze random signals.
Title: The Practical Matters of Including Patient Reported Outcomes in Pediatric Oncology Clinical CareEmily L Mueller, MD MSc1,2Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202Correspondence:Emily L Mueller, MD, MSc705 Riley Hospital Dr, ROC 4340Indianapolis, IN 46202Cell: 312-399-0245 Fax: firstname.lastname@example.orgAbstract word count: 0Main text word count: 6654Number of tables: 0Number of figures: 0Short Title: Practicalities of PRO in Clinical CareAbbreviations:
The Impella 5.5 with SmartAssist (Abiomed; Danvers, MA) is a life-saving treatment option in acute heart failure which utilizes a continuous heparin purge solution to prevent thrombosis. In patients with contraindications to heparin, alternative anticoagulation strategies are required. We describe the stepwise management of anticoagulation in a coagulopathic patient with persistent cardiogenic shock following a coronary artery bypass procedure who underwent Impella 5.5 placement. A direct thrombin inhibitor-based purge solution was utilized while evaluating for heparin-induced thrombocytopenia. Use of a novel bicarbonate-based purge solution (BBPS) was successfully used due to severe coagulopathy. There were no episodes of pump thrombosis or episodes of severe bleeding on the BBPS and systemic effects of alkalosis and hypernatremia were minimal.
Obstetric care for women that use antidepressants in pregnancyLine Kolding, MD, PhDVera Ehrenstein, MPH, DSc, ProfessorLars Pedersen, MSc, PhD, ProfessorPuk Sandager, MD, PhD, Associate ProfessorOlav B. Petersen, MD, PhD, ProfessorNiels Uldbjerg, MD, DMSc, ProfessorLars H. Pedersen, MD, PhD, ProfessorCorresponding:Lars Henning PedersenAarhus University Hospital / Aarhus UniversityPalle Juul-Jensens Blvd. 99, 8200 Aarhus N, DenmarkEmail: email@example.comPhone: +45 50526512We are grateful to Drs. Braillon and Bewley for their interest in our recent paper in the BJOG 1 and would like to elaborate on some of the important points they raise.We agree with Braillon and Bewley on the urgent need for improved pharmacovigilance of medication in pregnancy in general, and for antidepressants in particular. There are excellent international collaborations (e.g., the EuroCat) and local initiatives (e.g., the Swedish JanusInfo), but clinically we’re often forced to rely on very limited information indeed. Systematic international recording as suggested by Braillon and Bewley would represent an important step forward.On a smaller scale, we are establishing an automated surveillance system based on curated data that include information on both pre- and postnatally diagnosed malformations. We have, however, faced substantial legal and bureaucratic challenges, and have been forced to use data from the Central Denmark Region only, instead of national data. The surveillance system is consequently based on information on approx. 75,000 pregnancies, and even though it has the potential to aide clinical management, it is a drop in the ocean of the huge potential of for instance a comparable European collaboration.In our study, we used ≥2 redeemed prescriptions to define exposure with a prevalence 1.1%.1 The prevalence of pregnant women that redeemed ≥1 prescription was 3.2% (p. 3/ Table S1), and even though this is likely an overestimation due to non-adherence, the estimates are in line with previously reported prevalences in Scandinavia.2Braillon and Bewley emphasise the need to also consider non-pharmacological treatment of some pregnant women with depression and, further, to provide evidence-based and individualised treatment of women in the reproductive ages. Optimal individualised care will definitely result in non-pharmacological treatment of some pregnant women but, reversely, will cause yet other women to continue or initiate pharmacological treatment. This is in line with what is almost a truism in this field, that the potential harmful foetal effects must be balanced against the potential benefits of a pharmacological treatment, but it is no easy task. Pregnant women might overestimate the foetal risks associated with use of medication3 and discontinue important treatment, on the other hand some may use medication when there may be a better alternative for them. Regardless, we need to provide optimal obstetric care for the pregnant women that choose treatment with antidepressants. If our results are correct, prenatal follow-up of pregnant women treated with venlafaxine may include targeted foetal heart scans, even though the underlying causal explanation for the observed association with cardiac malformations is undetermined.1. Kolding L, Ehrenstein V, Pedersen L, Sandager P, Petersen OB, Uldbjerg N, et al. Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study. BJOG. 2021 May 25.2. Zoega H, Kieler H, Norgaard M, Furu K, Valdimarsdottir U, Brandt L, et al. Use of SSRI and SNRI Antidepressants during Pregnancy: A Population-Based Study from Denmark, Iceland, Norway and Sweden. PLoS One. 2015;10(12):e0144474.3. Wolgast E, Lindh-Åstrand L, Lilliecreutz C. Women’s perceptions of medication use during pregnancy and breastfeeding—A Swedish cross-sectional questionnaire study. Acta Obstetricia et Gynecologica Scandinavica. 2019;98(7):856-64.
Objectives To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. Design National retrospective and prospective audit Setting 48 UK secondary care ENT departments Participants Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. Main outcome measures Cases were divided into: Period 1 (01/11/19-15/03/20) before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1&2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). Results 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in Dec 2020-Feb 2021. Patient age differed between period 1&2 (3.2 Vs 4.7 years respectively, p<0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% Vs 24.3%, p=0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. Conclusion The COVID-19 pandemic led to a significant change in the presentation and case-mix of acute paediatric mastoiditis in the UK.
Since the first in-human implantation, trans-catheter aortic valve replacement (TAVR) has shown an exciting development in both technical and technological terms, becoming the standard of care for many patients, even not only inoperable ones. Although trans-femoral (TF) access has the scepter of first-line route for TAVR, in some cases, this access is not feasible, so several alternative routes were introduces over time. The network meta-analysis by Hameed et al has the great merit to provide a comprehensive picture. Hence, through either direct and indirect comparison, the authors confirmed as TF is the gold standard as access, followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic (trans apical and trans-aortic) routes are the least safe and should be reserved only to sporadic cases.
The concentration and homeostasis of intracellular phosphate (Pi) are crucial for sustaining cell metabolism and growth. During short-term Pi starvation, intracellular Pi is maintained relatively constant at the expense of vacuolar Pi. After the vacuolar stored Pi is exhausted, the plant cells induce the synthesis of intracellular acid phosphatase (APase) to recycle Pi from expendable organic phosphate (Po). In this study, the expression, enzymatic activity and subcellular localization of ACID PHOSPHATASE 1 (OsACP1) were determined. OsACP1 expression is specifically induced in almost all cell types of leaves and roots under Pi stress conditions. OsACP1 encodes an acid phosphatase with broad Po substrates and localizes in the endoplasmic reticulum (ER) and Golgi apparatus (GA). Phylogenic analysis demonstrates that OsACP1 has a similar structure with human acid phosphatase PHOSPHO1. Overexpression or mutation of OsACP1 affected Po degradation and utilization, which further influenced plant growth and productivity under both Pi-sufficient and Pi-deficient conditions. Moreover, overexpression of OsACP1 significantly affected intracellular Pi homeostasis and Pi starvation signalling. We concluded that OsACP1 is an active acid phosphatase that regulates rice growth under Pi stress conditions by recycling Pi from Po in the ER and GA.
Hospital administrations and providers are more than ever in need for new technologies and innovative methods with clinical benefit at lower costs. Surgeons and clinicians depend on conventional risk stratification scores developed to allow physicians to establish the risk of perioperative mortality. However, the current practiced models of preventive cardiology largely depend on patient motivation and awareness to be able to apply such risk scores appropriately. It was not until the appearance of miniaturized pocket-sized, user-friendly digital technologies that the awareness started to grow, highlighting the importance of role of technology and artificial intelligence (AI) in modern day medicine.
Enlargement of left ventricular outflow tract using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach for the hypertrophic obstructive cardiomyopathy Zhang et al (1) describe their experience in septal myectomy for hypertrophic obstructive cardiomyopathy. Of 247 consecutive cases with HOCM treated during 2016-2019 with a variety of techniques, this report is on 16 patients who underwent trans-mitral septal myectomy and enlargement of left ventricular outflow with an autologous pericardial patch in transverse configuration. The technique reportedly decreased the gradient from average 90+ to 10+ mm Hg and resolved systolic anterior leaflet motion in all with only mild residual mitral regurgitation. There were no deaths or any other major complications in this group. It is a small group of patients with excellent result but no definitive conclusion can be drawn regarding validity of the technique from this study. The controversy remains regarding the approach, trans-aortic vs. trans-mitral and whether leaflets should be left alone, plicated or lengthened as well as whether mitral valve should be repaired or replaced in addition to septal myectomy. One certainty remains, extended myectomy done either way, is the foundation of the surgical treatment of hypertrophic cardiomyopathy.
Background: Cognitive impairment is very common in patients with hypertension, it’s necessary to conduct a meta-analysis to evaluate the association of cognitive function and blood pressure variability in patients with hypertension, to provide insights into the clinical management of hypertension and cognitive impairment. Methods: We searched PubMed et al databases for the case-control studies on the association between blood pressure variability and cognitive function up to July 15, 2021. Two researchers independently screened the literature and retrieved the data. RevMan 5.3 was used for data meta-analysis Results: A total of 13 studies involving 2754 patients were included. Meta-analysis indicated that 24-hour systolic [MD= 3.54, 95% CI (2.48, 4.60)] and diastolic [MD=2.43, 95%CI (1.55, 3.31)] blood pressure variation coefficient in the CI group were significantly higher than that of no CI group (all P<0.05). Standard deviation of systolic [MD=2.20, 95% CI (0.27, 4.13)] and diastolic [MD=1.79, 95% CI (0.80, 2.79)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). Mean systolic [MD=3.73, 95% CI (0.92, 6.53)]and diastolic [MD = 5.41, 95% CI (0.42, 10.40)] blood pressure variation in the CI group were significantly higher than that of no CI group (all P<0.05). There were no statistically significant differences in the morning peak systolic [MD=7.85,95% CI (-1.30,17.01)] and diastolic [MD=4.44,95% CI (-6.00, 14.89)] blood pressure drop between the CI group and no CI group(all P>0.05). Conclusion: Cognitive impairment in hypertensive patients is closely associated with increased blood pressure variability, and clinical medical staff should pay attention to the management of blood pressure variability in hypertensive patients to reduce the development of cognitive impairments.
Introduction: Standard two-dimensional (2D), phased-array intracardiac echocardiography (ICE) is routinely used to guide interventional electrophysiology (EP) procedures. A novel four-dimensional (4D) ICE catheter (VeriSight Pro®, Philips, Andover, MA) can obtain 2D and three-dimensional (3D) volumetric images and cine-videos in real time (4D). The purpose of this study was to determine the early feasibility and safety of this 4D ICE catheter during EP procedures. Methods: The 4D ICE catheter was placed from the femoral vein in ten patients into various cardiac chambers to guide EP procedures requiring transseptal catheterization, including ablation for atrial fibrillation and left atrial appendage closure. 2D- and 3D- ICE images were acquired in real time by the electrophysiologist. A dedicated imaging expert performed digital steering to optimize and post-process 4D images. Results: Eight patients underwent pulmonary vein isolation (cryoballoon in 7 patients, pulsed field ablation in 1, additional radiofrequency left atrial ablation in 1). Two patients underwent left atrial appendage closure. High quality images of cardiac structures, transseptal catheterization equipment, guide sheaths, ablation tools, and closure devices were acquired with the ICE catheter tip positioned in the right atrium, left atrium, pulmonary vein, coronary sinus, right ventricle, and pulmonary artery. There were no complications. Conclusion: This is the first-in-human experience of a novel deflectable 4D ICE catheter used to guide EP procedures. 4D ICE imaging in safe and allows for acquisition of high-quality 2D and 3D images in real-time. Further use of 4D ICE will be needed to determine its added value for each EP procedure type.