Predictors of severe postoperative hyperglycemia after cardiac surgery in infants: a single-center, retrospective, observational study

Abstract

Purpose

Hyperglycemia is a common issue in infants after cardiac surgery for congenital heart disease. Poor glycemic control is suspected to be associated with adverse postoperative outcomes. This study was performed to investigate clinical factors contributing to hyperglycemia in the perioperative period in infats.

Methods

A total of 69 infants (aged 1–12 months) who were admitted to Yokohama City University Hospital Intensive Care Unit (ICU) after surgical repair of congenital heart diseases with cardiopulmonary bypass (CPB) were retrospectively analysed. Hyperglycemia was defined as blood glucose ≥ 250 mg/dL on ICU admission. Clinical background, operative factors, and postoperative factors were compared between the hyperglycemic and non-hyperglycemic groups. Additionally, multivariate analysis was performed to identify factors contributing to hyperglycemia.

Results

Nineteen (27.5%) and 50 (72.5%) infants were classified into the hyperglycemic and non-hyperglycemic groups, respectively. Hyperglycemic infants were significantly younger, shorter, and weighed less, with a higher rate of chromosomal abnormalities. Intraoperatively, they also experienced longer CPB and surgery times and had higher peak lactate levels and higher inotropic requirements. Hyperglycemia was related to longer mechanical ventilation and longer ICU stays. Multivariate analysis detected intraoperative hyperglycemia, longer CPB time, younger age and chromosomal abnormality as significant factors.

Conclusion

Adding to hyperglycemia during the operation, longer CPB time younger age and chromosomal abnormality were identified as predictors of high blood glucose levels at ICU admission.

http://ift.tt/2musO5I

Reversible symptoms present in a patient with Balo's concentric sclerosis

Edyta Dziadkowiak, Mieszko Zagrajek, Anna Zimny, Bogusław Paradowski

Neurology India 2018 66(1):268-268



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Neurosurgery as it was

RN Roy

Neurology India 2018 66(1):2-3



http://ift.tt/2CUpZRV

Sertraline-induced reversible myopathy with rhabdomyolysis and trismus

Boby V Maramattom, Joe Thomas, Nanda Kachhare

Neurology India 2018 66(1):235-237



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Changing trends in surgery for suprasellar lesions

Bhawani Shanker Sharma, Dattaraj Paramanand Sawarkar

Neurology India 2018 66(1):4-8



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Russel Brain: Some reflections on genius and other essays

Sunil Pandya

Neurology India 2018 66(1):290-293



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Evolution of concepts in the management of vestibular schwannomas: Lessons learnt from Prof B Ramamurthi's article published in 1970

Sunil Kumar Gupta, Manjul Tripathi

Neurology India 2018 66(1):9-19



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Dirofilariasis mimicking an osteoma

M Sreekumar, Jayashree Goethe, Roshith H Chekkattu

Neurology India 2018 66(1):255-256



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A medical-legal perspective on overlapping surgery

Alan M Scarrow

Neurology India 2018 66(1):20-23

In the U.S., there has recently been increased scrutiny on the appropriateness of surgeons performing overlapping cases and the potential for adverse consequences. This article describes the current literature on overlapping surgery and the ethics that guide behavior by performing a review of the PUBMED literature on overlapping surgery and analysis. Although the literature on overlapping surgery supports it as a safe practice, some public opinion runs contrary to the data, which is driving changes in policy. Surgeons should become familiar with the overlapping surgery policy in the hospital(s) in which they practice and be mindful of the potential consequences of performing overlapping surgeries.

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Authors' Reply: Magnesium supplementation in intracerebral hematoma: The hope and the hype!

Mukesh K Bhaskar, Bal Krishna Ojha, Rajesh Verma

Neurology India 2018 66(1):282-283



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Cerebrospinal fluid shunts – How they work: The basics

Sandip Chatterjee, L Harischandra

Neurology India 2018 66(1):24-35



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Association of hemolysis, elevated liver enzymes, low platelets syndrome with posterior reversible encephalopathy and intracranial hypotension

Zahide Yılmaz, Nuray Voyvoda, Pinar Bekdik Şirinocak, Hasan Terzi

Neurology India 2018 66(1):226-227



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Current status of dystonias including Meige's syndrome

Madhuri Behari

Neurology India 2018 66(1):36-37



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Lumber nerve root cavernous angioma

Shu-xin Sun, Ji Zhang, Ji-cheng Sun, Zhi-jie Chen, Xiang-heng Zhang, Zheng-he Chen, Jing-xiu Huang, Yu Jiang, Yong-gao Mou, Zhong-ping Chen, Ke Sai

Neurology India 2018 66(1):244-245



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Botulinum toxin in patients with Meige's syndrome

Nirosen Vijiaratnam, Tissa Wijeratne

Neurology India 2018 66(1):38-39



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Nasu–Hakola Disease

Bedia Samanci, Çağri Ulukan, Tuncay Gündüz, Murat Kürtüncü, Mefkure Eraksoy

Neurology India 2018 66(1):263-263



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Management of intracranial arterial dissection

Girish Rajpal, Vikas Naik

Neurology India 2018 66(1):40-42



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The Indo-US Collaborative Stroke Registry and infrastructure development project

Dheeraj Khurana, Jeyaraj Pandian, PN Sylaja, Subhash Kaul, MV Padma Srivastava, Suruchi Thakur, Deepti Arora, Tijy Thankachan, Aneesh B Singhal

Neurology India 2018 66(1):276-278



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Endovascular management of vertebral artery dissecting aneurysms

Vipul Gupta, Rajsrinivas Parthasarathy

Neurology India 2018 66(1):43-45



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Subgaleoatrial or subgaleopleural shunt?

Suryanarayanan Bhaskar, Mayank Garg

Neurology India 2018 66(1):285-286



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Dissecting aneurysms of the vertebrobasilar system with non-traumatic subarachnoid haemorrhage: Therapeutic considerations

Eike Immo Piechowiak, Jan Gralla

Neurology India 2018 66(1):46-48



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Supplementing dietary rosemary ( Rosmarinus officinalis L.) powder and vitamin E in broiler chickens: evaluation of humoral immune response, lymphoid organs, and blood proteins

Abstract

The aim of the present study was to evaluate the effect rosemary (Rosmarinus officinalis L.) powder (RP) and vitamin E (VE) at different levels on humoral immunity of broilers during a 42-day production cycle. A total of 270 1-day-old male chicks were assigned to nine groups with three replicates of ten birds each, and diets were supplemented with 0, 0.5, or 1.0% RP and 0, 100, or 200 mg/kg VE, respectively. Commercial-inactivated vaccines against avian influenza (AI) and Newcastle disease (ND) viruses, and living infectious bronchitis virus (IBV) vaccine were administered by spray method. Sheep red blood cells (SRBC) were administered subcutaneously. Blood samples were collected from birds 1 week after each vaccination to determine antibody titers. At the 42nd day, blood samples were also assessed for globulin level, and lymphoid tissues (thymus, spleen, and bursa) were weighed. Neither antibody titers against viruses nor lymphoid tissues weight were affected by RP and/or VE (P > 0.05) treatments. However, broilers supplemented with 0 mg/kg of VE had lower antibody titers against SRBC than those fed 100 mg/kg of VE (P < 0.05) at the 24th day. A significant RP × VE interaction effect (P < 0.05) on plasma globulin level was observed. The findings of our study suggest that dietary RP and VE additives can interact and modulate the humoral immunity of broilers, but not sufficiently to improve antibody titers against specific virus during a 42-day production cycle.

http://ift.tt/2mtWqjU

Testing the role of external debt in environmental degradation: empirical evidence from Turkey

Abstract

This study investigates the role of external debt stock in Turkey, which has suffered from heavy (external and domestic) debt stock for many years. Annual data from 1960 to 2013 was analyzed using time series analysis in order to study this. The results confirm the validity of the conventional environmental Kuznets curve (EKC) in the case of Turkey. However, this study also found that Turkey's external debt stock did not influence the Turkish economy's long-term EKC behavior. Fortunately, the results suggest that there are important interactions among external debt stock, CO₂ emissions, energy consumption, and real income; that is, changes in external debt volume precede changes in these aggregates' volumes.

http://ift.tt/2qVl69F

Contrasting effects of alkaline amendments on the bioavailability and uptake of Cd in rice plants in a Cd-contaminated acid paddy soil

Abstract

Reducing cadmium (Cd) concentrations in rice grains is important for food safety, particularly in acid paddy fields in South China where the soils have been previously contaminated with Cd. A field experiment was conducted to evaluate the effects of four alkaline amendments, i.e., lime, compost, biochar, and carbide slag on soil bioavailability and uptake of Cd in plants of two rice cultivars (Oryza sativa L.) in a Cd-contaminated acid paddy soil. The addition of these amendments significantly decreased the concentrations of CaCl₂-extractable Cd by 13–41%. Cd in the acid-soluble fraction was decreased in these amended soils while it increased in the residual fraction. The amendments also decreased the uptake of Cd in the plants at the tillering and mature growth stages. The concentrations of Cd in plant tissues at maturity were in the order: root > shoot > bran > polished rice > husk. The amendment of carbide slag decreased Cd concentration in rice grains the most, followed by lime, biochar, and compost. The increases in soil pH and the decreases in the acid-soluble fraction of Cd (F1-Cd) indicated that these amendments can directly transform the highly availability fraction of Cd to a more stable fraction (residual Cd fraction) in soils. Furthermore, the Cd concentrations in polished rice grains of the two rice cultivars used were reduced by 66–67% by treatment with carbide slag. Our study suggests that carbide slag has a great potential to reduce the bioavailability and uptake of Cd in rice plants in Cd-contaminated acid paddy field soils.

http://ift.tt/2mtw6Gw

Linear doggybone DNA vaccine induces similar immunological responses to conventional plasmid DNA independently of immune recognition by TLR9 in a pre-clinical model

Abstract

Vaccination with DNA that encodes cancer antigens is a simple and convenient way to raise immunity against cancer and has already shown promise in the clinical setting. Conventional plasmid DNA is commonly used which together with the encoded antigen also includes bacterial immunostimulatory CpG motifs to target the DNA sensor Toll-like receptor 9. Recently DNA vaccines using doggybone DNA (dbDNA™), have been developed without the use of bacteria. The cell-free process relies on the use of Phi29 DNA polymerase to amplify the template followed by protelomerase TelN to complete individual closed linear DNA. The resulting DNA contains the required antigenic sequence, a promoter and a poly A tail but lacks bacterial sequences such as an antibiotic resistance gene, prompting the question of immunogenicity. Here we compared the ability of doggybone DNA vaccine with plasmid DNA vaccine to induce adaptive immunity using clinically relevant oncotargets E6 and E7 from HPV. We demonstrate that despite the inability to trigger TLR9, doggybone DNA was able to induce similar levels of cellular and humoral immunity as plasmid DNA, with suppression of established TC-1 tumours.

http://ift.tt/2EAJbV7

Satisfaction in rhinoplasty: the possible impact of anxiety and functional outcome

Abstract

Background

Rhinoplasty is a complex but commonly applied surgical procedure. Patient satisfaction is the least discussed but one of the most important determinants of surgical success.

Objectives

Evaluation of the patient satisfaction together with surgeon satisfaction were the main goals of this study. The roles of anxiety, gender, age and follow-up period were also studied.

Patients and methods

53 eligible patients operated by the first two authors within the previous 2 years were enrolled in the study. The medical records were reviewed for demographic data as well as the details of the surgical procedure. Functional and esthetic satisfactions of the patients were evaluated by VAS and ROE respectively. Surgeon satisfaction was evaluated by VAS in crosswise manner. Anxiety was measured by STAI_s and STAI_t scales.

Results

The analysis concerning esthetic results as well as functional results did not reveal any significant difference between the two surgeons (p = 0.132, p = 0.43 respectively). ROE scores were significantly different among patients with "good" and "very good" functional results. The difference between surgeon satisfaction and patient satisfaction was found to be insignificant (p = 0.273). Correlation analysis yielded a positive correlation between STAI_I and STAI_II (Pearson r = 0.335, p = 0.014) but not between STAI scores and ROE scores. Moreover, there was no relation between anxiety scores and the functional results. Likely, gender as well as age, follow-up, and surgical technique were not found to have any effect on patient satisfaction either.

Conclusion

Patient satisfaction is preferential in rhinoplasty. In our patient series, patient satisfaction was shown to be correlated with functional outcome but not with surgeon satisfaction. Anxiety was not found to have a significant impact on results of rhinoplasty. Our results should be interpreted cautiously keeping in mind that our patients' primary drive for rhinoplasty was functional.

http://ift.tt/2CU6l8y

Rhythmic Spontaneous Activity Mediates the Age-Related Decline in Somatosensory Function

Abstract

Sensory gating is a neurophysiological process whereby the response to a second stimulus in a pair of identical stimuli is attenuated, and it is thought to reflect the capacity of the CNS to preserve neural resources for behaviorally relevant stimuli. Such gating is observed across multiple sensory modalities and is modulated by age, but the mechanisms involved are not understood. In this study, we examined somatosensory gating in 68 healthy adults using magnetoencephalography (MEG) and advanced oscillatory and time-domain analysis methods. MEG data underwent source reconstruction and peak voxel time series data were extracted to evaluate the dynamics of somatosensory gating, and the impact of spontaneous neural activity immediately preceding the stimulation. We found that gating declined with increasing age and that older adults had significantly reduced gating relative to younger adults, suggesting impaired local inhibitory function. Most importantly, older adults had significantly elevated spontaneous activity preceding the stimulation, and this effect fully mediated the impact of aging on sensory gating. In conclusion, gating in the somatosensory system declines with advancing age and this effect is directly tied to increased spontaneous neural activity in the primary somatosensory cortices, which is likely secondary to age-related declines in local GABA inhibitory function.

http://ift.tt/2mkuT3f

Gli2 Rescues Delays in Brain Development Induced by Kif3a Dysfunction

Abstract

The primary cilium in neural stem cells plays distinct roles in different stages during cortical development. Ciliary dysfunctions in human (i.e., ciliopathy) cause developmental defects in multiple organs, including brain developmental delays, which lead to intellectual disabilities and cognitive deficits. However, effective treatment to this devastating developmental disorder is still lacking. Here, we first investigated the effects of ciliopathy on neural stem cells by knocking down Kif3a, a kinesin II motor required for ciliogenesis, in the neurogenic stage of cortical development by in utero electroporation of mouse embryos. Brains electroporated with Kif3a shRNA showed defects in neuronal migration and differentiation, delays in neural stem cell cycle progression, and failures in interkinetic nuclear migration. Interestingly, introduction of Gli1 and Gli2 both can restore the cell cycle progression by elevating cyclin D1 in neural stem cells. Remarkably, enforced Gli2 expression, but not Gli1, partially restored the ability of Kif3a-knockdown neurons to differentiate and move from the germinal ventricular zone to the cortical plate. Moreover, Cyclin D1 knockdown abolished Gli2's rescue effect. These findings suggest Gli2 may rescue neural stem cell proliferation, differentiation and migration through Cyclin D1 pathway and may serve as a potential therapeutic target for human ciliopathy syndromes through modulating the progression of neural stem cell cycle.

http://ift.tt/2D3tUPn

The Roles of Subdivisions of Human Insula in Emotion Perception and Auditory Processing

Abstract

Previous studies have shown insular activations involving sensory, motor, and affective processing. However, the functional roles of subdivisions within the human insula are still not well understood. In the present study, we used intracranial electroencephalography and electrical cortical stimulation to investigate the causal roles of subdivisions of the insula in auditory emotion perception in epilepsy patients implanted with depth electrodes in this brain region. The posterior and the anterior subdivisions of the human insula, identified based on structural and functional analyses, showed distinct response properties to auditory emotional stimuli. The posterior insula showed auditory responses that resemble those observed in Heschl's gyrus, whereas the anterior insula (AI) responded to the emotional contents of the auditory stimuli in a similar way as observed in the amygdala. Furthermore, the degree of the differentiation between various emotion types increased from the posterior to the AI. Our findings suggest different roles played by the two regions of the human insula and a transformation from sensory to affective representations in auditory modality along the posterior-to-anterior axis in the human insula.

http://ift.tt/2mkcQKE

Streptococcus oralis maintains homeostasis in supragingival biofilms by antagonizing cariogenic pathogen Streptococcus mutans

Summary

Bacteria residing in oral biofilms live in a state of dynamic equilibrium with one another. The intricate synergistic or antagonistic interactions between them are crucial for determining this balance. Using the 6-species Zürich "supragingival" biofilm model, this study aimed to investigate interactions regarding growth and localization of the constituent species. As control, an inoculum containing all six strains was used, whereas in each of the further five inocula one of the bacterial species was absent, and in the last both streptococci were absent. Biofilms were grown anaerobically on hydroxyapatite discs, and after 64 h they were harvested and quantified by culture analyses. For visualization, fluorescence in situ hybridization and confocal laser scanning microscopy was used. Compared to the control, no statistically significant difference of total CFU was observed in the absence of any of the biofilm species, except for F. nucleatum whose absence caused a significant decrease in total bacterial numbers. Absence of S. oralis resulted in a significant decrease in A. oris, and increase in S. mutans (p<0.001). Absence of A. oris, V. dispar or S. mutans did not cause any changes. The structure of the biofilm with regards to the localization of the species did not result in observable changes. In summary, the most striking observation was that absence of S. oralis resulted in limited growth of commensal A. oris and overgrowth of S. mutans. This data establishes S. oralis as commensal keeper of homeostasis in the biofilm by antagonizing S. mutans, thus preventing a caries-favoring dysbiotic state.

This article is protected by copyright. All rights reserved.

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Vaccines for the Paramyxoviruses and Pneumoviruses: Successes, Candidates, and Hurdles

Viral Immunology , Vol. 0, No. 0.


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Biochar amendment with fertilizers increases peanut N uptake, alleviates soil N 2 O emissions without affecting NH 3 volatilization in field experiments

Abstract

Biochar application to soil is currently widely advocated for a variety of reasons related to sustainability. However, the synergistic effects of biochar combined with mineral or organic fertilizer on soil N₂O emissions, NH₃ volatilization, and plant N uptake are poorly documented. Field plot experiments planted with peanut were conducted under the application of biochar (derived from rice husk and cottonseed husk, 50 t ha⁻¹) with organic or mineral fertilizer. It was found that biochar increased soil nutrient availability and decreased surface soil bulk density, demonstrating that biochar could improve the soil quality especially in the 0–20-cm profile. The total N content of the plant changed little with treatments, but the kernel N concentration increased significantly when biochar was applied with organic fertilizer. Peanut yield increased with biochar amendment while no significant difference was observed in plant biomass, suggesting biochar had a positive effect on belowground biomass. Peanut N uptake was also increased following biochar amendment with either organic or mineral fertilizers. While biochar amendment had no significant effect on soil NH₃ volatilization, it did decrease the cumulative N₂O emission by 36.3% on average with organic fertilizer, and by 32.6% with mineral fertilizer, respectively (p < 0.05). The copy numbers of 16S rDNA, nifH, nirK, and nirS were not influenced by the application of biochar; however, the copy number of nosZ was significantly increased under biochar plus mineral fertilizer treatment. The results imply that biochar application can suppress N₂O emissions, as a result of abiotic factors and enhanced peanut N uptake rather than changes of denitrification genes.

http://ift.tt/2mupLKL

Agro-industrial waste recycling by Trichosporon fermentans : conversion of waste sweetpotato vines alone into lipid

Abstract

Agro-industrial waste can be used to replace traditional carbohydrates, such as sucrose, starch, and glucose in many industrial fermentation processes. This study investigated the conversion of pre-treated waste sweetpotato vines (SV) into lipid by Trichosporon fermentans under the separate hydrolysis and fermentation (SHF) and the simultaneous saccharification and fermentation (SSF) processes. The results showed that SV autoclaving significantly increased the lipid accumulation of T. fermentans compared with acid or alkaline hydrolysis. The effects of different pre-treatments on SV were also studied by scanning electron microscopy and Fourier transform infrared spectroscopy, which showed the partial removal of the aliphatic fractions, hemicelluloses, and lignin during pre-treatment. Moreover, the lipid yield of T. fermentans in SSF was 6.98 g L⁻¹, which was threefold higher than that (2.79 g L⁻¹) in SHF, and the lipid contents of yeast in SSF and SHF were 36 and 25%, respectively. Overall, this study indicated that SSF using autoclaved SV could increase the growth and lipid production of T. fermentans and provided an efficient way to realize the resource utilization of waste SV.

http://ift.tt/2r1qHeH

Investigation of the effect of rapid and slow external pH increases on Enterococcus faecalis biofilm grown on dentine

Abstract

Background

Calcium hydroxide is a common endodontic medicament and has an anti-microbial effect by increasing the localized pH within the root canal. However, Enterococcus faecalis has shown some resistance to calcium hydroxide.

Method

A flow cell apparatus was used to grow an E. faecalis biofilm on dentine discs. Following 4 weeks growth in Todd Hewitt Broth, flow cells were exposed to either a rapid or slow increase to pH 11.5 or 12.5. Cellular viability was determined using serial plating and the number of colony forming units was normalised against the cellular protein content. Scanning electron microscopy was carried out to qualitatively observe the effects of the different rates of pH increase.

Results

A significant difference in viability between the pH rapid and slow groups was not shown in this study. Compared to pH 11.5 solutions, pH 12.5 solutions were more effective at killing bacteria although some E. faecalis still survived.

Conclusion

E. faecalis did not adapt and develop a greater resistance to high pH following a slow rise in pH compared with a rapid rise in pH. As expected, pH 12.5 was more effective in reducing bacterial numbers compared to pH 11.5 although E. faecalis was not completely eliminated.

This article is protected by copyright. All rights reserved.

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A prospective cohort-study of 122 adult patients presenting to an otolaryngologist's office with globus pharyngeus

Abstract

Objectives

To investigate the epidemiology of globus pharyngeus in adult patients presenting to the otolaryngologist's office. Also the predictors of persisting symptoms, prevalence of anxiety and the effect of clinical assessment were analyzed.

Design

This was a prospective cohort study. Follow-up was done using a postal questionnaire.

Setting

One otolaryngologists' office comprising three medical doctors.

Participants

122 consecutive globus patients presenting to one otolaryngology office in a one-year period.

Main outcome measures

Globus incidence, gender- and age-distribution, predictors of persisting symptoms and the patient's health related concerns.

Results

3.8% of first-time visits were regarding globus. The mean age was 48 years [range 20-88 y] and a female predominance was found (ratio 1.49). 84% experienced anxiety, mainly due to fear of cancer. The most common pathological findings were reflux (15.6%) and post-infectious inflammation (10.6%). 21.4% of questionnaire-responders reported full remission of their symptoms. Three predictors regarding symptom persistence were identified: Male gender (OR 1.52), smoking (OR 3.4) and difficulties in breathing (OR 8.7). Patients with concomitant foreign body sensation were less likely to have persisting symptoms (OR 0.42). No cases of malignant disease were encountered. 94.7% was reassured by the office visit.

Conclusion

The incidence of globus is 3.8% in the otolaryngologist's office. Female gender and concomitant foreign body sensation were predictive for presenting to the clinic even if symptom remission had occurred. Male gender, smoking and self-perceived breathing difficulties were predictive for persisting symptoms. Globus is an anxiety causing symptom, but reassurance is provided by clinical examination by the otolaryngologist.

This article is protected by copyright. All rights reserved.

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A Differential Diagnosis of a Head and Neck Bony Lesion: Review of a Case Series with 18 Patients with Extra-Intestinal Features of Familial Adenomatous Polyposis

Abstract

We would like to draw to the attention of head and neck surgeons the following disease that can present first to head and neck specialists with either a head and neck lump or following an incidental finding on radiological imaging. Familial Adenomatous Polyposis (FAP) is a hereditary disease caused by a mutation in the APC gene on chromosome 5, which is inherited in an autosomal dominant fashion with complete penetrance but variable expression(1). However in approximately 25% of cases it arises from a de novo mutation of the APC gene(1).

This article is protected by copyright. All rights reserved.

http://ift.tt/2ARN05U

Five-year outcome of endoscopic laser cricopharyngeal myotomy: our experience in 10 patients

Abstract

Cricopharyngeal spasm is a failure of the cricopharyngeus muscle to relax and can be a cause of dysphagia.

Endoscopic laser cricopharyngeal myotomy with mucosal repair is associated with reduced operative times, inpatient stay and lower morbidity with favourable subjective short-term outcomes, although long-term outcomes are less well known.

In our cohort of patients, the majority had a subjectively improved swallow in the long-term although some did have regression of symptoms but remained better than pre-operatively.

Subjectively our cohort of patients appeared to favour less well in the long-term with regards to reflux symptoms, the majority fairing worse than pre-operatively at least 5 years previously.

This paper would suggest that as clinicians we can advise patients that in the long-term, laser cricopharyngeal myotomy will improve and maintain swallowing symptoms but that their reflux symptoms may be exacerbated over time.

This article is protected by copyright. All rights reserved.

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Editorial Board

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Table of Contents

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Title Page

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An ultrasensitive detection of miRNA-155 in breast cancer via direct hybridization assay using two-dimensional molybdenum disulfide field-effect transistor biosensor

Publication date: 15 May 2018
Source:Biosensors and Bioelectronics, Volume 105
Author(s): Samira Mansouri Majd, Abdollah Salimi, Foad Ghasemi
MicroRNAs (miRNAs), critical biomarkers of acute and chronic diseases, play key regulatory roles in many biological processes. As a result, robust assay platforms to enable an accurate and efficient detection of low-level miRNAs in complex biological samples are of great significance. In this work, a label-free and direct hybridization assay using molybdenum disulfide (MoS2) field-effect transistor (FET) biosensor has been developed for ultrasensitive detection of miRNA-155 as a breast cancer biomarker in human serum and cell-line samples. MoS2, the novel 2D layered material with excellent physical and chemical properties, was prepared through sequential solvent exchange method and was used as an active channel material. MoS2 was comprehensively characterized by spectroscopic and microscopic methods and it was applied for fabrication of FET device by drop-casting MoS2 flacks suspension onto the FET surface. MoS2 FET device showed a relatively low subthreshold swing of 48.10mV/decade and a high mobility of 1.98 × 10³cm²V⁻¹s⁻¹. Subsequently, probe miRNA-155 strands were immobilized on the surface of the MoS2 FET device. Under optimized conditions detection limit of 0.03fM and concentration range 0.1fM to 10nM were achieved. The developed biosensor not only was capable to identification of fully matched versus one-base mismatch miRNA-155 sequence, but also it could detect target miRNA-155 in spiked real human serum and extracts from human breast cancer cell-line samples. This approach paves a way for label-free, early detection of miRNA as a biomarker in cancer diagnostics with very high sensitivity and good specificity, thus offering a significant potential for clinical application.

Graphical abstract

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A catalytic and dual recycling amplification ATP sensor based on target-driven allosteric structure switching of aptamer beacons

Publication date: 15 May 2018
Source:Biosensors and Bioelectronics, Volume 105
Author(s): Ying Peng, Daxiu Li, Ruo Yuan, Yun Xiang
Abnormal concentrations of ATP are associated with many diseases and cancers, and quantitative detection of ATP is thus of great importance for disease diagnosis and prognosis. In the present work, we report a new dual recycling amplification sensor integrated with catalytic hairpin assembly (CHA) to achieve high sensitivity for fluorescent detection of ATP. The association of the target ATP with the aptamer beacons causes the allosteric structure switching of the aptamer beacons to expose the toehold regions, which hybridize with and unfold the fluorescently quenched hairpin signal probes (HP1) to recycle the target ATP and to trigger CHA between HP1 and the secondary hairpin probes (HP2) to form HP1/HP2 duplexes. Due to the recycling amplification, the presence of ATP leads to the formation of many HP1/HP2 duplexes, generating dramatically amplified fluorescent signals for sensitive detection of ATP. Under optimal experimental conditions, our sensor linearly responds to ATP in the range from 25 to 600nM with a calculated detection limit of 8.2nM. Furthermore, the sensor shows a high selectivity and can also be used to detect ATP in human serums to realize its application for real samples. With the distinct advantage of significant signal amplification without the involvement of any nanomaterial and enzyme, the developed sensor thus holds great potential for simple and sensitive detection of different small molecules and proteins.



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Editorial Board

Publication date: 15 April 2018
Source:Biosensors and Bioelectronics, Volume 102





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A quantitative CT imaging signature predicts survival and complements established prognosticators in stage I non-small cell lung cancer

Publication date: Available online 10 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Juheon Lee, Bailiang Li, Yi Cui, Xiaoli Sun, Jia Wu, Hui Zhu, Jinming Yu, Michael F. Gensheimer, Billy W. Loo, Maximilian Diehn, Ruijiang Li
BackgroundPrognostic biomarkers are needed to guide the management of early stage non-small cell lung cancer (NSCLC). This work aims to develop an image-based prognostic signature and assess its complementary value to existing biomarkers.MethodsWe retrospectively analyzed outcomes of stage I NSCLC in seven cohorts. Based on an analysis of 39 CT features characterizing tumor and its relation to neighboring pleura, we developed a prognostic signature in an institutional cohort (n=117) and tested it in an external cohort (n=88). A third cohort of 89 patients with CT and gene expression data was employed to create a surrogate genomic signature of the imaging signature. We conducted further validation using data from five gene expression cohorts (n=639), and built a composite signature by integrating with the cell-cycle progression (CCP) score and clinical variables.ResultsAn imaging signature consisting of pleural contact index and normalized inverse difference was significantly associated with overall survival in both imaging cohorts (p=0.0005 and 0.0009). Functional enrichment analysis revealed that genes highly correlated with the imaging signature were related to immune response, such as lymphocyte activation and chemotaxis (false discovery rate<0.05). A genomic surrogate of the imaging signature remained a significant predictor of survival adjusting for known prognostic factors (hazard ratio: 1.81, 95% CI: 1.34-2.44, p<0.0001), and stratified patients within subgroups as defined by stage, histology, or CCP score. A composite signature outperformed the genomic surrogate, CCP score, and clinical model alone (p<0.01) regarding concordance index (0.70 vs 0.62-0.63).ConclusionThe proposed CT imaging signature reflects fundamental biologic differences in tumors and predicts overall survival in patients with stage I NSCLC. When combined with established prognosticators, the imaging signature improves survival prediction.

Teaser

We identified a CT imaging signature that predicts overall survival in stage I NSCLC. The imaging signature is associated with immune response and may serve as a noninvasive prognostic biomarker in stage I NSCLC.


http://ift.tt/2mlNE6r

Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis

Abstract

Background

In the last two decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results.

Aim

This systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes.

Methods

We performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta-analyses of eligible studies were carried out using the random-effects model.

Results

We identified 39 eligible articles (37 observational studies and 2 randomised controlled trials (RCT)). Meta-analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.20 to 3.83, p= 0.01, and OR 1.63, 95% CI 1.03 to 2.56, p=0.04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta-analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring.

Limitations

Although studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I² 72-79%).

Conclusion

Maternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently there is no evidence that levothyroxine treatment, when initiated 8 to 20 weeks gestation (mostly between 12-17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ARJYPl

Successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation: A case report and review

Bader Abu Ghalyoun, Matthew Lempel, Hamid Shaaban, Fayez Shamoon

Annals of Cardiac Anaesthesia 2018 21(1):76-77

A 32-year-old woman with a past medical history of paroxysmal atrial fibrillation, long QT syndrome, and implantation of an automatic iimplantable cardioverter-defibrillator (AICD) following cardiac arrest presented with disabling symptoms of paroxysmal atrial fibrillation due to recurrent AICD shocks. Before curative ablation, transesophageal echocardiography was performed to assess for existing thrombi. This is a rare case of successful resolution with apixaban of a massive left atrial appendage thrombus due to non-rheumatic atrial fibrillation that was successfully treated with apixaban.

http://ift.tt/2CSyJYK

Noninvasive ventilation using bipap: Expanding indications to post cardiac surgery care

William T McGee

Annals of Cardiac Anaesthesia 2018 21(1):6-7



http://ift.tt/2DleYKe

Pneumopericardium after minimally invasive atrial septal defect closure

Aditya Lamba, Rahul Dutta, Rajesh K Chand

Annals of Cardiac Anaesthesia 2018 21(1):99-100

Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.

http://ift.tt/2CUsDqB

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

Sébastien Champion, Laëtitia Zieger, Caroline Hemery

Annals of Cardiac Anaesthesia 2018 21(1):8-14

Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167–0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.

http://ift.tt/2DoIVsI

Concomitant neurogenic and vascular thoracic outlet syndrome due to multiple exostoses

Hosseinali Abdolrazaghi, Azade Riyahi, Morteza Taghavi, Pezhman Farshidmehr, Abolfazl Mohammadbeigi

Annals of Cardiac Anaesthesia 2018 21(1):71-73

We report a rare case of multiple hereditary exostosis where patient presented with bilateral base of neck exostoses with concurrent compression of brachial plexus and subclavian artery and vein. The patient was a young 26-year-old woman with chief complaints of pain in the left upper extremity, paresthesia in the left ring and little finger, and weakness in hand movement and grip. On referral, history, physical examination, radiological imaging, and electrodiagnostic tests evaluated the patient. Due to severe pain and disability in performing routine activities, surgical intervention was necessary. In the current case, the patient had thoracic outlet syndrome with concomitant venous, arterial, and neurogenic sub types. Radial pulse returned and pain associated with brachial plexus compression was resolved after the surgery.

http://ift.tt/2CTTZgs

Retrospective study of complete atrioventricular canal defects: Anesthetic and perioperative challenges

Aniruddha Ramesh Janai, Wilfried Bellinghausen, Edwin Turton, Carmine Bevilacqua, Waseem Zakhary, Martin Kostelka, Farhad Bakhtiary, Joerg Hambsch, Ingo Daehnert, Florian Loeffelbein, Joerg Ender

Annals of Cardiac Anaesthesia 2018 21(1):15-21

Objective: The objective of this study was to highlight anesthetic and perioperative management and the outcomes of infants with complete atrioventricular (AV) canal defects. Design: This retrospective descriptive study included children who underwent staged and primary biventricular repair for complete AV canal defects from 1999 to 2013. Setting: A single-center study at a university affiliated heart center. Participants: One hundred and fifty-seven patients with a mean age at surgery of 125 ± 56.9 days were included in the study. About 63.6% of them were diagnosed as Down syndrome. Mean body weight at surgery was 5.6 ± 6.3 kg. Methods: Primary and staged biventricular repair of complete AV canal defects. Measurements and main results: A predefined protocol including timing of surgery, management of induction and maintenance of anesthesia, cardiopulmonary bypass, and perioperative intensive care treatment was used throughout the study. Demographic data as well as intraoperative and perioperative Intensive Care Unit (ICU) data, such as length of stay in ICU, total duration of ventilation including reintubations, and total length of stay in hospital and in hospital mortality, were collected from the clinical information system. Pulmonary hypertension was noted in 60% of patients from which 30% needed nitric oxide therapy. Nearly 2.5% of patients needed permanent pacemaker implantation. Thorax was closed secondarily in 7% of patients. In 3.8% of patients, reoperations due to residual defects were undertaken. Duration of hospital stay was 14.5 ± 4.7 days. The in-hospital mortality was 0%. Conclusion: Protocolized perioperative management leads to excellent outcome in AV canal defect repair surgery.

http://ift.tt/2DleJPk

Mechanical discordance between left atrium and left atrial appendage

Arash Khamooshian, Jelliffe Jeganthan, Yannis Amador, Roger J Laham, Feroze Mahmood, Robina Matyal

Annals of Cardiac Anaesthesia 2018 21(1):82-84

During standard transesophageal echocardiographic examinations in sinus rhythm (SR) patients, the left atrial appendage (LAA) is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.

http://ift.tt/2CTgimJ

Dexmedetomidine for prevention of skeletal muscle ischaemia-reperfusion injury in patients with chronic limb ischaemia undergoing aortobifemoral bypass surgery: A prospective double-blind randomized controlled study

Tanveer Singh Kundra, Ashwini Thimmarayappa, Manasa Dhananjaya, N Manjunatha

Annals of Cardiac Anaesthesia 2018 21(1):22-25

Background: Dexmedetomidine is a selective α-2 agonist used for sedation. It has also been shown to have myocardial protective effect and prevent ischemia-reperfusion injury in off-pump coronary artery bypass patients. The aim of our study was to assess the effect of dexmedetomidine for prevention of skeletal muscle ischemia-reperfusion injury in patients undergoing aortobifemoral bypass surgery. Methodology: Sixty adult patients (Group dexmedetomidine n = 30, Group normal saline n = 30) undergoing aortobifemoral bypass surgery were recruited over 3 months. Randomization was done using a computer-generated random table. The attending anesthesiologist would be blinded to whether the drug/normal saline was being administered. He would consider each unlabeled syringe as containing dexmedetomidine and calculate the volume to be infused via a syringe pump accordingly. Dexmedetomidine infusion (1 mcg/kg) over 15 minutes was given as a loading dose, followed by maintenance infusion of 0.5 mcg/kg/h till 2 h postprocedure in Group dexmedetomidine (D) while the same volume of normal saline was given in the control Group C till 2 h postprocedure. Creatine phosphokinase (CPK) values were noted at baseline (T0), 6 h (T1), 12 h (T2), and 24 h (T3) after the procedure. Hemodynamic variables (heart rate [HR] and mean blood pressure [MAP]) were recorded at T0, T1, T2, and T3. Results were analyzed using unpaired Student's t-test, P < 0.05 was considered statistically significant. Results: MAP and HR significantly decreased in Group D as compared to control group (P < 0.05). However, the decrease was never <20% of the baseline. The CPK values at 6, 12, and 24 h were statistically significant between the two groups. Conclusion: Dexmedetomidine prevents skeletal muscle ischemia-reperfusion injury in patients undergoing aortobifemoral bypass surgery.

http://ift.tt/2DnMW0T

Atrioventricular septal defects

Sandeep Chauhan

Annals of Cardiac Anaesthesia 2018 21(1):1-3



http://ift.tt/2Dl9sqT

Design and standardization of tools for assessing the perceived heart risk and heart health literacy in Iran

Habibolah Khazaei, Saeid Komasi, Ali Zakiei, Mohsen Rezaei, Peyman Hatamian, Mohammad Jashnpoor, Mozhgan Saeidi

Annals of Cardiac Anaesthesia 2018 21(1):46-52

Objectives: The aim is to achieve the standard tools for heart health, the present study aimed to design, develop, and standardize the two questionnaires of perceived heart risk scale (PHRS) and heart health literacy scale (HHLS). Methods: The present study was a methodological research conducted on the residents of Kermanshah Province, Iran, using the multi-stage cluster sampling. Further, considering the scientific methods in the psychometric field, the design of the research questionnaires was conducted. In addition, the viewpoints of experts in different domains were qualitatively and quantitatively included to assess the validity of the questionnaires. To assess the reliability of the questionnaires, a sample including 31 subjects was first selected and studied within a fortnight's interval. Then, the reliability and validity of the scales were assessed using factor analysis and Cronbach's alpha in a sample of 771 subjects. Results: After reviewing the viewpoints of experts, the items were adjusted and implemented in the first sample at two stages. The results were indicative of the stability and acceptability of the Cronbach's alpha. In addition, the validity and reliability of the questionnaires were confirmed in the second sample too. Conclusion: According to the results of the present study, it can be concluded that the two questionnaires of PHRS and HHLS had acceptable reliability and validity.

http://ift.tt/2CSLbYg

In response to: Unsolved enigma of atrial myxoma with biventricular dysfunction

Aanchal Dixit, Prabhat Tewari, Rashmi Soori, Surendra Kumar Agarwal

Annals of Cardiac Anaesthesia 2018 21(1):107-107

Thanks to Raut et al.[1] for appreciating our efforts in managing the case of biatrial myxomas. A brief discussion is warranted here on the types, size of cardiac myxomas, interleukin 6 (IL-6) levels, left ventricle (LV) dysfunction, and their relation. IL-6 is a pleiotropic cytokine with a variety of biologic activities, including differentiation of B cell, thymocytes, and T cells; activation of macrophages; and stimulation of hepatocyte to produce acute-phase proteins such as C-reactive protein.[2],[3] It is also said to have paracrine, endocrine, and autocrine growth functions.[3]

http://ift.tt/2DkzXgd

Successful resolution with apixaban of a massive left atrial appendage thrombus due to nonrheumatic atrial fibrillation: A case report and review

Bader Abu Ghalyoun, Matthew Lempel, Hamid Shaaban, Fayez Shamoon

Annals of Cardiac Anaesthesia 2018 21(1):76-77

A 32-year-old woman with a past medical history of paroxysmal atrial fibrillation, long QT syndrome, and implantation of an automatic iimplantable cardioverter-defibrillator (AICD) following cardiac arrest presented with disabling symptoms of paroxysmal atrial fibrillation due to recurrent AICD shocks. Before curative ablation, transesophageal echocardiography was performed to assess for existing thrombi. This is a rare case of successful resolution with apixaban of a massive left atrial appendage thrombus due to non-rheumatic atrial fibrillation that was successfully treated with apixaban.

http://ift.tt/2CSyJYK

Noninvasive ventilation using bipap: Expanding indications to post cardiac surgery care

William T McGee

Annals of Cardiac Anaesthesia 2018 21(1):6-7



http://ift.tt/2DleYKe

Pneumopericardium after minimally invasive atrial septal defect closure

Aditya Lamba, Rahul Dutta, Rajesh K Chand

Annals of Cardiac Anaesthesia 2018 21(1):99-100

Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.

http://ift.tt/2CUsDqB

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

Sébastien Champion, Laëtitia Zieger, Caroline Hemery

Annals of Cardiac Anaesthesia 2018 21(1):8-14

Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. Setting and Design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included. Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices. Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167–0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported. Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.

http://ift.tt/2DoIVsI

Concomitant neurogenic and vascular thoracic outlet syndrome due to multiple exostoses

Hosseinali Abdolrazaghi, Azade Riyahi, Morteza Taghavi, Pezhman Farshidmehr, Abolfazl Mohammadbeigi

Annals of Cardiac Anaesthesia 2018 21(1):71-73

We report a rare case of multiple hereditary exostosis where patient presented with bilateral base of neck exostoses with concurrent compression of brachial plexus and subclavian artery and vein. The patient was a young 26-year-old woman with chief complaints of pain in the left upper extremity, paresthesia in the left ring and little finger, and weakness in hand movement and grip. On referral, history, physical examination, radiological imaging, and electrodiagnostic tests evaluated the patient. Due to severe pain and disability in performing routine activities, surgical intervention was necessary. In the current case, the patient had thoracic outlet syndrome with concomitant venous, arterial, and neurogenic sub types. Radial pulse returned and pain associated with brachial plexus compression was resolved after the surgery.

http://ift.tt/2CTTZgs

Retrospective study of complete atrioventricular canal defects: Anesthetic and perioperative challenges

Aniruddha Ramesh Janai, Wilfried Bellinghausen, Edwin Turton, Carmine Bevilacqua, Waseem Zakhary, Martin Kostelka, Farhad Bakhtiary, Joerg Hambsch, Ingo Daehnert, Florian Loeffelbein, Joerg Ender

Annals of Cardiac Anaesthesia 2018 21(1):15-21

Objective: The objective of this study was to highlight anesthetic and perioperative management and the outcomes of infants with complete atrioventricular (AV) canal defects. Design: This retrospective descriptive study included children who underwent staged and primary biventricular repair for complete AV canal defects from 1999 to 2013. Setting: A single-center study at a university affiliated heart center. Participants: One hundred and fifty-seven patients with a mean age at surgery of 125 ± 56.9 days were included in the study. About 63.6% of them were diagnosed as Down syndrome. Mean body weight at surgery was 5.6 ± 6.3 kg. Methods: Primary and staged biventricular repair of complete AV canal defects. Measurements and main results: A predefined protocol including timing of surgery, management of induction and maintenance of anesthesia, cardiopulmonary bypass, and perioperative intensive care treatment was used throughout the study. Demographic data as well as intraoperative and perioperative Intensive Care Unit (ICU) data, such as length of stay in ICU, total duration of ventilation including reintubations, and total length of stay in hospital and in hospital mortality, were collected from the clinical information system. Pulmonary hypertension was noted in 60% of patients from which 30% needed nitric oxide therapy. Nearly 2.5% of patients needed permanent pacemaker implantation. Thorax was closed secondarily in 7% of patients. In 3.8% of patients, reoperations due to residual defects were undertaken. Duration of hospital stay was 14.5 ± 4.7 days. The in-hospital mortality was 0%. Conclusion: Protocolized perioperative management leads to excellent outcome in AV canal defect repair surgery.

http://ift.tt/2DleJPk

Mechanical discordance between left atrium and left atrial appendage

Arash Khamooshian, Jelliffe Jeganthan, Yannis Amador, Roger J Laham, Feroze Mahmood, Robina Matyal

Annals of Cardiac Anaesthesia 2018 21(1):82-84

During standard transesophageal echocardiographic examinations in sinus rhythm (SR) patients, the left atrial appendage (LAA) is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.

http://ift.tt/2CTgimJ

Spontaneous coronary artery dissection in anabolic steroid misuse

Aghighe Heidari, Feridoun Sabzi, Reza Faraji

Annals of Cardiac Anaesthesia 2018 21(1):103-104



http://ift.tt/2CWAc05

A randomized controlled trial comparing the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass, assessed by changes in N-terminal brain natriuretic peptide

Balaji Kuppuswamy, Kirubakaran Davis, Raj Sahajanandan, Manickam Ponniah

Annals of Cardiac Anaesthesia 2018 21(1):34-40

Objective: The objective of the study is to compare the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass (CPB), the cardio protection been assessed by changes in N-terminal brain natriuretic peptide (NT proBNP). Methodology and Design: This study is designed as a participant blinded, prospective randomized clinical trial. Setting: Christian Medical College Hospital, Vellore, India. Participants: Patients undergoing elective coronary artery bypass surgery on CPB. Intervention: Anesthesia was maintained with 0.8–1.2 end tidal concentrations of isoflurane in the isoflurane group and in the propofol group, anesthesia was maintained with propofol infusion as described by Roberts et al. Measurements: Hemodynamic data were recorded at frequent intervals during the surgery and up to 24 h in the Intensive Care Unit (ICU). The other variables that were measured include duration of mechanical ventilation, dose and duration of inotropes in ICU, (inotrope score), duration of ICU stay, NT proBNP levels before induction and 24 h postoperatively, creatine kinase-MB levels in the immediate postoperative, first and second day. Results: Mean heart rate was significantly higher in propofol group during sternotomy, (P = 0.021). Propofol group had a significantly more number of patients requiring nitroglycerine in the prebypass period (P = 0.01). The increase in NT proBNP from preoperative to postoperative value was lesser in the isoflurane group compared to propofol even though the difference was not statistically significant. The requirement of phenylephrine to maintain mean arterial pressure within 20% of baseline, mechanical ventilation duration, inotrope use, duration of ICU stay and hospital stay were found to be similar in both groups. Conclusion: Propofol exhibit comparable myocardial protective effect like that of isoflurane in patients undergoing coronary artery bypass graft surgery. Considering the unproven mortality benefit of isoflurane and the improved awareness of green OT concept, propofol may be the ideal alternative to volatile anesthetics, at least in patients with good left ventricular function.

http://ift.tt/2CSk0Ng

Atrioventricular septal defects

Sandeep Chauhan

Annals of Cardiac Anaesthesia 2018 21(1):1-3



http://ift.tt/2Dl9sqT

Long-term quality of life postacute kidney injury in cardiac surgery patients

Pankaj Kumar Mishra, Heyman Luckraz, Jayanta Nandi, Alan Nevill, Ramesh Giri, Andrew Panayiotou, Johann Nicholas

Annals of Cardiac Anaesthesia 2018 21(1):41-45

Background: Acute renal failure after cardiac surgery is known to be associated with significant short-term morbidity and mortality. There have as yet been no major reports on long-term quality of life (QOL). This study assessed the impact of acute kidney injury (AKI) and renal replacement therapy (RRT) on long-term survival and QOL after cardiac surgery. The need for long-term RRT is also assessed. Materials and Methods: Patients who underwent cardiac surgery between 2005 and 2011 (n = 6087) and developed AKI (RIFLE criteria, n = 570) were included. They were propensity-matched 1:1 to patients without renal impairment (control). Data were prospectively collected, and health-related QOL questionnaire was sent to patients who were alive at least 1-year postoperatively at the time of the study. Results: There was no significant difference in the preoperative characteristics between the two groups (age, gender, left ventricular ejection fraction, procedure, urgency, logistic Euroscore), respectively. Median follow-up was 52 months. Survival data were available in all patients. Questionnaires were returned in 64% of eligible patients. Long-term survival was significantly lower, and QOL, in particular the physical aspect, was significantly worse for the AKI group as compared to non-AKI group (38.8 vs. 44.2, P = 0.002), especially so in patients who required RRT. In alive respondents, despite an 18% (66/359) incidence of ongoing renal follow-up, the need for late RRT was only in 1.1% (4/359). Conclusion: AKI and especially the need for RRT following cardiac surgery are associated with increased long-term mortality as well as worse quality of life in a propensity-matched control group.

http://ift.tt/2CV4Xmd

Commentary: Comments on thoracic outlet syndrome

Gauranga Majumdar, Surendra Kumar Agarwal

Annals of Cardiac Anaesthesia 2018 21(1):74-75



http://ift.tt/2Dl0ZnE

Design and standardization of tools for assessing the perceived heart risk and heart health literacy in Iran

Habibolah Khazaei, Saeid Komasi, Ali Zakiei, Mohsen Rezaei, Peyman Hatamian, Mohammad Jashnpoor, Mozhgan Saeidi

Annals of Cardiac Anaesthesia 2018 21(1):46-52

Objectives: The aim is to achieve the standard tools for heart health, the present study aimed to design, develop, and standardize the two questionnaires of perceived heart risk scale (PHRS) and heart health literacy scale (HHLS). Methods: The present study was a methodological research conducted on the residents of Kermanshah Province, Iran, using the multi-stage cluster sampling. Further, considering the scientific methods in the psychometric field, the design of the research questionnaires was conducted. In addition, the viewpoints of experts in different domains were qualitatively and quantitatively included to assess the validity of the questionnaires. To assess the reliability of the questionnaires, a sample including 31 subjects was first selected and studied within a fortnight's interval. Then, the reliability and validity of the scales were assessed using factor analysis and Cronbach's alpha in a sample of 771 subjects. Results: After reviewing the viewpoints of experts, the items were adjusted and implemented in the first sample at two stages. The results were indicative of the stability and acceptability of the Cronbach's alpha. In addition, the validity and reliability of the questionnaires were confirmed in the second sample too. Conclusion: According to the results of the present study, it can be concluded that the two questionnaires of PHRS and HHLS had acceptable reliability and validity.

http://ift.tt/2CSLbYg

Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!!

Neeti Makhija, Rohan Magoon, Minati Choudhury, Sivasubramanian Ramakrishnan

Annals of Cardiac Anaesthesia 2018 21(1):78-81

Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon.

http://ift.tt/2DmkpJ0

The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes

Marziyeh Kaboudi, Fateme Dehghan, Arash Ziapour

Annals of Tropical Medicine and Public Health 2017 10(6):1709-1713

Background: Diagnosis of diabetes will have a significant impact on patients' psychosocial functioning and patients should devote sufficient time and energy to self-manage the disease. This study aimed to evaluate the effectiveness of treatment based on acceptance and commitment model on the mental health of women with diabetes type II. Methods: The present study is an experimental study with pretest-posttest control group design. The sample consisted of 26 women with diabetes from Kermanshah who were recruited using convenience (availability) sampling and were randomly divided into experimental and control groups. All patients completed the 28-item general health questionnaire before and after the intervention. Data were analyzed using univariate analysis of covariance and applying SPSS version 23. Results: The results clearly showed that the posttest scores of mental health in the experimental group were significant compared to the control group (P

http://ift.tt/2AR4qzB

Advocating for the implementation of recommended measures to improve infant and young child feeding

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(6):1835-1836



http://ift.tt/2D3Yklv

Saving lives of mothers and newborns from infections around the time of childbirth by strengthening health sector response to the public health concern of antibiotic resistance

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(6):1405-1406



http://ift.tt/2AQpEOl