Background. We have observed reopening of the occluded “no-touch” saphenous vein (NT SV) composite grafts on follow-up angiograms in patients who underwent coronary artery bypass graftings (CABG). Methods. Between 2008 and 2018, 1283 patients received NT SV conduits without or with surrounding pedicle tissue as composite grafts based on the in situ left internal thoracic artery (ITA) for CABG and underwent early postoperative angiographies. Among the 1283 patients, 53 patients showed 55 occluded SV conduit anastomoses, and 46 patients who had 48 occluded SV anastomoses were re-evaluated by 1-year postoperative angiographies. Results. Early postoperative angiographies in 1283 patients demonstrated overall occlusion rates of 1.2% (56/4518); occlusion rates of the ITA and SV were 0.08% (1/1259) and 1.7% (55/3260), respectively. One-year angiograms demonstrated that 14 occluded SV anastomoses (29.2% [14/48 occluded SV]) of 14 patients became patent. Reopening of occluded SV conduits occurred more frequently in NT SV with pedicle tissue than in NT SV without pedicle tissue (45.0% [9/20] versus 17.9% [5/28]; P=0.057). When we examined the preoperative and 1-year postoperative angiograms, reopening of the occluded SV conduits was not related with progression (P=0.258) or preoperative reversibility score (P=0.115) of native target coronary artery disease. Conclusions. More than a quarter of the occluded SV composite grafts on early postoperative angiograms were patent in the 1-year angiograms. The reopening rates were higher in patients who had received NT SV conduits with pedicle tissue than those who had received NT SV conduits without pedicle tissue.
Keratoacanthomas (KA) are epithelial tumors that present as rapidly evolving nodules with a central hyperkeratotic plug, and occasionally show signs of spontaneous regression. A 21-years-old patient strongly refused the diagnostic biopsy and insisted on a non surgical treatment. He was successfully treated with imiquimod 5% cream.
Background: Transrectal ultrasound biopsy is the preferred method for diagnosing prostate cancer, but it can cause infectious complications as a result of fluoroquinolone resistance. We aimed to explore the potential protective effect of a second rectal enema before biopsy. Methods: Between January 2015 and December 2020, 419 patients were assessed retrospectively. Patients with a history of anticoagulant use, uncontrolled diabetes, urological surgery, prostate biopsy, or recent hospitalization or overseas travel, as well as those with previous prostatitis, were excluded from the study. The patients were subsequently divided into two groups: Group 1 (n=223) had received one enema, on the morning of the biopsy, and Group 2 (n=196) had received two, with the additional enema administered half an hour before the procedure. Results: There was no significant difference between the groups in terms of age, BMI, diabetes, prostate-specific antigen (PSA) level, and prostate size (p=0.076, p=0.489, p=0.265, p=0.193, and p=0.661, respectively) or in relation to cancer detection (p=0.428). The median hospitalization date was significantly higher in Group 1 (p=0.003) as was UTI development (p=0.004). However, there was no significant difference in terms of fever and sepsis (p=0.524 and p=0.548, respectively). Additionally, subgroup analysis demonstrated that UTI was significantly lower in patients with diabetes mellitus who had received a second enema (p=0.004), though there was no significant difference in UTI between the groups in those without diabetes mellitus (p=0.215). Multivariable analysis showed that age and diabetes were significant risk factors for the development of UTI (p=0.002andp=0.003, respectively). Furthermore, the second enema was a significant protective factor for preventing UTI (p<0.001). Conclusion: Older age and the presence of diabetes mellitus are independent risk factors for UTI after prostate biopsy. A second enema procedure before biopsy may protect patients from related infectious complications and could therefore be used as an alternative preventative method.
Fatigue behavior of Al-Al and Al-steel refill friction stir spot welding joints Haokun Yang1a*, Detao Cai2,3a, Jiaxin Li1, Chin Yung Kwok1, Yunqiang Zhao3, Yu Li4, Haisheng Liu4, Waiwah Lai11 Smart Manufacturing Division (SMD), Hong Kong Productivity Council (HKPC), Hong Kong 999077, People’s Republic of China2 State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan 410082, People’s Republic of China3 China-Ukraine Belt and Road Joint Laboratory on Materials Joining and Advanced Manufacturing, China-Ukraine Institute of Welding Guangdong Academy of Sciences, Guangzhou, Guangdong 510650, People’s Republic of China4 Center for Industrial Analysis and Testing, Guangdong Academy of Science, Guangzhou, Guangdong 510650, People’s Republic of Chinaa These authors contribute equallyCorresponding author: Haokun Yang, +852 27885679,email@example.comKeywords: Refill friction stir spot welding, Fatigue fracture, Aluminum, Steel
There is increasing attention being given toward social and ethical implications of xenotransplantation that may begin relatively soon. IN a recent commentary by Loebe and Parker, the authors address many of the social and ethical issues in regard to xenotransplantation, but do so only superficially. This letter to the editor responds to many of the points they raise.
Division of labour occurs when cooperating individuals specialise to perform different tasks. In bacteria and other microorganisms, some species divide labour by random specialisation, where an individual’s role is determined by random fluctuations in biochemical reactions within the cell. Other species divide labour by coordinating across individuals to determine which cells will perform which task, using mechanisms such as between-cell signalling. However, previous theory, examining the evolution of mechanisms to divide labour between reproductives and sterile helpers, has only considered clonal populations, where there is no potential for conflict between individuals. We used a mixture of analytical and simulation models to examine non-clonal populations and found that: (1) intermediate levels of coordination can be favoured, between the extreme of no coordination (random) and full coordination; (2) as relatedness decreases, coordinated division of labour is less likely to be favoured. Our results can help explain why coordinated division of labour is relatively rare in bacteria, where groups may frequently be non-clonal.
This paper is devoted to the mathematical modeling of a combined effect of directional and bulk crystallization in a phase transition layer with allowance for nucleation and evolution of newly born particles. We consider two models with and without fluctuations in crystal growth velocities, which are analytically solved using the saddle-point technique. The particle-size distribution function, solid-phase fraction in a supercooled two-phase layer, its thickness and permeability, solidification velocity, and desupercooling kinetics are defined. This solution enables us to characterize the mushy layer composition. We show that the region adjacent to the liquid phase is almost free of crystals and has a constant temperature gradient. Crystals undergo intense growth leading to fast mushy layer desupercooling in the middle of a two-phase region. The mushy region adjacent to the solid material is filled with the growing solid phase structures and is almost desupercooled.
We read with interest the aforementioned paper by Al-Zubayer et al. 20211 that investigated the “double” and “triple” burden of non-communicable diseases defined as any two or three of hypertension, diabetes and overweight/obesity, respectively. When the prevalence of individual condition was examined it was found that “Almost 56% had hypertension, 23.4% had diabetes and 24.6% had overweight or obesity”.We think the authors have made errors in their analysis that has resulted in unreliable prevalence estimates of hypertension, diabetes and overweight/obesity, and casting doubt on their estimates of burden of non-communicable diseases. This will cause confusion in the scientific and wider community and at worst, inappropriate allocation of resources to address the artificially elevated burden of diseases. We have identified errors related to the calculation of mean blood pressure, definition of diabetes, and classification of overweight/obesity, as outlined below.Al-Zubayer et al. 2021 state that “interviewers have measured the respondents’ blood pressure and it was taken at the beginning, in the middle and at the end of each interview. The mean value of these measurements was documented as the final result to measure hypertension1”. The Bangladesh Demographic and Health Survey (BDHS) survey did measure blood pressure three times, however, the report states that “The average of the second and third measurements was used to report respondents’ blood pressure values”2. This is a standard practice in research and clinical practice to reduce the possibility of ‘white coat’ hypertension from the first reading. The classification of hypertension based on the mean of all three measurements may have resulted in higher means, and an overestimate of the prevalence of hypertension.The authors also state that “If the fasting plasma glucose values were >6.1 mmol/L (110 mg/dL) and/or taking any medicine for diabetes, then the participant is considered to be diabetic otherwise normal.”1 However, this is an incorrect definition of diabetes because it includes pre-diabetes . Fasting blood glucose in the range 6.1 to 6.9 mmol/L is the level for pre-diabetes, as recommended by the WHO3. It is also not the classification used in the BDHS survey report which states that “Individuals were considered as having raised blood glucose or diabetes if they had a fasting blood glucose (FBG) equivalent level of 7 mmol/L or above at the time of the survey or reported currently taking prescribed medication for their high blood glucose or diabetes”2, which is consistent with the WHO classification3. As a result of including prediabetes, the prevalence of ‘diabetes’ reported by the authors (23.4%) was more than double that reported in the BDHS survey report (10%)2.Al-Zubayer et al. 2021 used the WHO global cut-off for overweight/obesity (BMI ≥25kg/m2). However, we think it would have been more appropriate to use Asian cut-offs (BMI ≥23kg/m2) as suggested by the WHO expert consultation4. This is due to the high risk of type 2 diabetes and cardiovascular disease in Asian people at lower BMIs than the WHO global cut-offs4.We believe these are important misinterpretations, which need to be addressed by the authors.
Machine learning and artificial intelligence (AI) in medicine has arrived in medicine and the healthcare community is experiencing significant growth in its adoption across numerous patient care settings. There are countless applications for machine learning and AI in medicine ranging from patient outcome prediction, to clinical decision support, to predicting future patient therapeutic setpoints. This commentary discusses a recent application leveraging machine learning to predict one year patient survival following orthotopic heart transplantation. This modeling approach has significant implications in terms of improving clinical decision making, patient counseling, and ultimately organ allocation and has been shown to significantly outperform preexisting algorithms. This commentary also discusses how adoption and advancement of this modeling approach in the future can provide increased personalization of patient care. The continued expansion of information systems and growth of electronic patient data sources in healthcare will continue to pave the way for increased use and adoption of data science in medicine. Personalized medicine has been a long-standing goal of the healthcare community and with machine learning and AI now being continually incorporated into clinical settings and practice, this technology is well on the pathway to make a considerable impact to greatly improve patient care in the near future.
Potential protective effects of breast milk and amniotic fluid against novel coronavirus SARS-CoV-2.Authors: April Rees1, Stephen Turner2, Catherine Thornton1*1 Institute of Life Science, Swansea University Medical School, Swansea, Wales, UK, SA2 8PP2 University of Aberdeen, The Institute of Applied Health Sciences, Aberdeen, Scotland, UK AB24 3FXDisclosure: The authors report no conflict of interest.Funding: This work was supported by the EPSRC Impact Acceleration Account at Swansea University and the Welsh Government Sêr Cymru III Tackling COVID-19 initiative.*Corresponding author:Professor Cathy ThorntonILS1, Swansea University Medical SchoolSingleton CampusSwansea UniversitySwansea, Wales, UKSA2 8PPTelephone: 01792 602122Email: firstname.lastname@example.orgKeywords: Breast milk, amniotic fluid, SARS-CoV-2, neonateWord count: 769
Pulmonary artery pseudoaneurysms are a rare but potentially lethal diagnosis. They can be further categorized by etiology or location and are typically successfully treated with endovascular therapies. However, they occasionally require operative intervention. Here, we present a case of a patient who presented with a central pulmonary artery pseudoaneurysm on CT scan with unclear etiology that was initially treated with conservative management. However, this was noted to have rapid enlargement on interval imaging necessitating urgent surgical intervention. The patient underwent a median sternotomy, anterior pulmonary artery arteriotomy for exposure, exclusion of the posterior artery pseudoaneurysm with a bovine pericardial patch, and closure of the anterior arteriotomy with a bovine pericardial patch. The patient did well and was discharged on postoperative day eleven with repeat imaging showing resolution.
Null hypothesis significance testing (NHST) and p-values are widespread in the cardiac surgical literature but are frequently misunderstood and misused. The purpose of the review is to discuss major disadvantages of p-values and suggest alternatives. We describe diagnostic tests, the prosecutor’s fallacy in the courtroom, and NHST, which involve inter-related conditional probabilities, to help clarify the meaning of p-values, and discuss the enormous sampling variability, or unreliability, of p-values. Finally, we use a cardiac surgical database and simulations to explore further issues involving p-values. In clinical studies, p-values provide a poor summary of the observed treatment effect, whereas the three- number summary provided by effect estimates and confidence intervals is more informative and minimises over-interpretation of a “significant” result. P-values are an unreliable measure of strength of evidence; if used at all they give only, at best, a very rough guide to decision making. Researchers should adopt Open Science practices to improve the trustworthiness of research and, where possible, use estimation (three-number summaries) or other better techniques.
Patients with severely calcified aorta undergoing conventional cardiac surgery are at increased risk for postoperative neurologic deficits. Implementation of cerebroprotective devices may substantially reduce or even eliminate the risk of adverse neurologic event, thus enabling surgical therapy, especially when interventional treatment cannot be considered an alternative option.
Cryptococcosis is an invasive, opportunistic, fungal infection that predominantly effects the respiratory tract and central nervous system in immunocompromised patients. It is classically associated with defects in cellular immunity such as acquired immunodeficiency syndrome. Here we describe a case of life-threatening laryngitis, endobronchitis and pneumonia due to Cryptococcus neoformans in a teenager with hypogammaglobulinaemia. To the best of our knowledge, no previous cases of laryngeal cryptococcosis have been reported in the paediatric population.