This essay explores John Paul II’s intellectual legacy as a champion for a theocentric view of culture that emphasizes the human person and human dignity in quest for human self-realization in a ...community that seeks the transcendence of God. His theopocentric vision for culture is defined in the context of the teaching of the Second Vatican Council. John Paul’s theological anthropology is grounded in personalism, communion, dialogue, and freedom. When God is eclipsed from human activity, particularly via the “shadow” of secularism, it engenders the crisis of culture. John Paul’s articulation of dialogue emphasizes inculturation and evangelization. His Trinitarian and social encyclicals reflect a theocentric and anthropocentric vision for culture, while his Polish and literary background show his thoughts on culture not as teachings but as integrated into his life experience. The essay concludes with reflections on Mary and the challenge of dialogue in a multicultural world.
Structural valvular deterioration of xenogenic heart valve replacements is thought to be due to a chronic immune response. We sought to engineer porcine extracellular matrix that elicits minimal ...inflammatory immune response.
Whole blood, bone marrow and pericardium were collected from patients undergoing elective cardiac surgery. Porcine extracellular matrix was decellularized, reseeded with homologous mesenchymal stem cells and exposed to whole blood.
DAPI stain confirmed the absence of cells after decellularization, and presence of mesenchymal stem cells after recellularization. There was a significant reduction in IL-1β and TNF-α production in the recellularized matrix.
Recellularization of porcine matrix is successful at attenuating the xenogenic immune response and may provide a suitable scaffold to address the current limitations of prosthetic heart valve replacements.
Transcatheter Valve-in-Valve: A Cautionary Tale Luc, Jessica G.Y; Shanks, Miriam, MD, PhD; Tyrrell, Benjamin D., MD ...
The Annals of thoracic surgery,
09/2016, Letnik:
102, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Transcatheter aortic valve replacement (TAVR) by valve-in-valve (VIV) implantation is an alternative treatment for high-risk patients with a degenerating aortic bioprosthesis. We present a case of ...transapical TAVR VIV with a 29-mm Edwards SAPIEN XT (ESV) (Edwards Lifesciences, Irvine, CA) into a 29-mm Medtronic Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, MN) in which unanticipated dilatation of the Freestyle bioprosthesis resulted in intraprocedural embolization of the TAVR valve, necessitating urgent conversion to a conventional surgical aortic valve replacement (AVR). Our experience suggests that TAVR VIV with the 29-mm ESV in the setting of a degenerated 29-mm Freestyle stentless bioprosthesis must be undertaken with caution.
Available cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and ...EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG).
All patients who underwent isolated CABG (2002 - 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality.
Octogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845).
All risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.
In this paper, the chromatic alteration of various types of paints, present on mural painting fragments derived from the vaults of The Upper Basilica of Saint Francis of Assisi in Italy (12th–13th ...century), is studied using synchrotron radiation. Six painted mural fragments, several square centimeters in size, were available for analysis, originating from the ceiling paintings attributed to Cimabue and Giotto; they correspond to originally white, blue/green, and brown/yellow/orange areas showing discoloration. As well as collecting macroscopic X-ray fluorescence and diffraction maps from the entire fragments in the laboratory and at the SOLEIL synchrotron, corresponding paint cross-sections were also analyzed using microscopic X-ray fluorescence and powder diffraction mapping at the PETRA-III synchrotron. Numerous secondary products were observed on the painted surfaces, such as (a) copper tri-hydroxychloride in green/blue areas; (b) corderoite and calomel in vermillion red/cinnabar-rich paints; (c) plattnerite and/or scrutinyite assumed to be oxidation products of (hydro)cerussite (2PbCO3·Pb(OH)2) in the white areas, and (d) the calcium oxalates whewellite and weddellite. An extensive presence of chlorinated metal salts points to the central role of chlorine-containing compounds during the degradation of the 800-year-old paint, leading to, among other things, the formation of the rare mineral cumengeite (21PbCl2·20Cu(OH)2·6H2O).
Abstract This position statement addresses issues in revascularization for multivessel coronary artery disease (CAD) from the perspective of both cardiologists and cardiac surgeons. Recommendations ...are made based on evidence from clinical trials and observational studies, with an emphasis on the increasing number of individuals with significant comorbid disease burden and functional debilitation who are being referred for definitive management of their multivessel CAD in the context of routine clinical practice. These types of individuals have traditionally not been included in the many clinical trials that have been the basis for guidelines and recommendations, and the objective of the proposed medical intervention or revascularization (or both) would not necessarily be to improve prognosis but to improve quality of life. One purpose of this document is to propose practical multidisciplinary approaches to the management of these patients. Recommendations are made for revascularization in acute coronary syndromes and stable CAD, with specific considerations for individuals with left ventricular dysfunction and heart failure, chronic renal failure, and chronic obstructive pulmonary disease. We also consider the use of various risk scores, including the Society of Thoracic Surgeons score, the EuroSCORE, and the SYNTAX II score. The importance of a heart team approach is also emphasized. The complementary role of coronary bypass surgery and percutaneous coronary intervention is highlighted, along with the importance of optimal medical therapy.
Chronic mitral regurgitation (MR) remains a common cardiovascular condition resulting in significant morbidity and mortality. With an aging population, increasing trends for both primary ...(degenerative) and secondary (functional) MR have become apparent. Although the gold standard remains surgical intervention with mitral valve repair/replacement, comorbid conditions have steered the development of less invasive technologies to mitigate perioperative surgical risk. Transcatheter mitral valve repair using a percutaneous edge-to-edge technique is the most widely available choice at present. However, other transcatheter mitral valve repair techniques such as annuloplasty and chordal implantation are notable alternatives. Moreover, emerging technologies in transcatheter mitral valve replacement are rapidly establishing their roles in the field of chronic severe MR therapy. Hence, it is imperative to understand the indications and limitations of these various transcatheter mitral valve interventions to provide the best and most up-to-date clinical care for patients. This review will outline current evidence and patient selection criteria for such device-based therapies.
L'insuffisance mitrale chronique est un trouble cardiovasculaire courant encore associé à des taux de morbidité et de mortalité importants. Le vieillissement de la population fait ressortir une tendance à la hausse des insuffisances mitrales primaires (dégénératives) et secondaires (fonctionnelles) au fil du temps. Bien que le traitement de référence demeure une intervention chirurgicale consistant à réparer ou à remplacer la valve mitrale, les troubles concomitants ont stimulé la mise au point de méthodes moins invasives afin de réduire le risque chirurgical périopératoire. La réparation transcathéter de la valve mitrale par fermeture bord à bord est la méthode la plus utilisée à l’heure actuelle. Toutefois, d’autres techniques de réparation transcathéter de la valve mitrale, comme l’annuloplastie et l’implantation de cordages, constituent aussi des options intéressantes. En outre, de nouvelles technologies de remplacement transcathéter de la valve mitrale sont rapidement en train de s’imposer pour le traitement de l'insuffisance mitrale chronique grave. Il est donc impératif de bien comprendre les indications et les limites de ces différentes interventions transcathéter touchant la valve mitrale afin d’offrir aux patients les meilleurs soins de pointe. La revue présente donc les données probantes actuelles et les critères de sélection des patients admissibles à de tels traitements faisant appel à des dispositifs de correction.
The plant bugs Lygus hesperus Knight (Hemiptera: Miridae) and L. lineolaris (Palisot de Beauvois) have emerged as economic pests of cotton in the United States. These hemipteran species are ...refractory to the insect control traits found in genetically modified commercial varieties of cotton. In this article, we report the isolation and characterization of a 35 kDa crystal protein from Bacillus thuringiensis, designated TIC807, which causes reduced mass gain and mortality of L. hesperus and L. lineolaris nymphs when presented in an artificial diet feeding assay. Cotton plants expressing the TIC807 protein were observed to impact the survival and development of L. hesperus nymphs in a concentration-dependent manner. These results, demonstrating in planta activity of a Lygus insecticidal protein, represent an important milestone in the development of cotton varieties protected from Lygus feeding damage.
There is limited information about the impact of frailty on public payer costs in cardiac surgery. This study aimed to determine quality-adjusted life-years (QALYs) and costs associated with ...preoperative frailty in patients referred for cardiac surgery.
We retrospectively compared costs of frailty in a cohort of 529 patients aged ≥ 50 years who were referred for nonemergent cardiac surgery in Alberta. Patients were screened preoperatively for frailty, defined as a score of 5 or greater on the Clinical Frailty Scale. The primary outcome measure was public payer costs attributable to frailty, calculated in a difference-in-difference (DID) model.
The prevalence of frailty was 10% (n = 51; 95% confidence interval CI, 7%-12%). Median (interquartile range) costs for frail patients were higher in the first year postsurgery ($200,709 $146,177-$486,852 vs $147,730 $100,674-$177,025; P < 0.001) compared to nonfrail; the difference-in-difference attributable cost of frailty was $57,836 (95% CI, $–28,608-$144,280). At 1 year, frail patients had fewer QALYs realized compared to nonfrail patients (0.71 0.57-0.77 vs 0.82 0.75-0.86, P < 0.001), whereas QALYs gained were similar (0.02 –0.02-0.05 vs 0.02 0.00–0.04, P = 0.58, median difference 0.003 95% CI, –0.01-0.02) in frail and nonfrail patients.
Frailty screening identified a population with greater impairment in quality-of-life and greater healthcare costs. Costs attributable to frailty represent opportunity costs that should be considered in future cardiac surgical services planning in the context of our aging population and the growing prevalence of frailty.
Il existe peu de renseignements concernant les répercussions de la fragilité sur les coûts pour les payeurs publics en chirurgie cardiaque. Cette étude visait à déterminer les années de vie pondérées par la qualité (QALY, pour Quality-Adjusted Life-Years) et les coûts associés à la fragilité préopératoire chez les patients dirigés vers un service de chirurgie cardiaque.
Nous avons comparé de façon rétrospective les coûts de la fragilité dans une cohorte de 529 patients âgés de 50 ans ou plus qui ont été dirigés vers un service de chirurgie cardiaque pour une intervention non urgente en Alberta. Un dépistage de la fragilité, définie comme un score de 5 ou plus à l’échelle CFS (Clinical Frailty Scale), a été effectué avant l’intervention. Le principal critère d’évaluation était le coût attribuable à la fragilité pour les payeurs publics, calculé selon un modèle d’écart des différences.
La prévalence de la fragilité a été de 10 % (n = 51; intervalle de confiance IC à 95 % : 7 à 12 %). Les coûts médians (écart interquartile) dans la première année suivant l’intervention chirurgicale ont été plus élevés chez les patients fragiles que chez les patients non fragiles (200 709 $ 146 177 $ à 486 852 $ contre 147 730 $ 100 674 $ à 177 025 $; p < 0,001); le coût attribuable de la fragilité selon le modèle d’écart des différences a été de 57 836 $ (IC à 95 % : −28 608 $ à 144 280 $). À 1 an, les patients fragiles avaient moins de QALY réalisées que les patients non fragiles (0,71 0,57 à 0,77 contre 0,82 0,75 à 0,86; p < 0,001), alors que le nombre de QALY gagnées était similaire (0,02 −0,02 à 0,05 contre 0,02 0,00 à 0,04; p = 0,58; différence médiane : 0,003 IC à 95 % : −0,01 à 0,02) chez les patients fragiles et non fragiles.
Le dépistage de la fragilité a permis de repérer une population associée à une perte plus importante de qualité de vie et à des coûts plus élevés en soins de santé. Les coûts attribuables à la fragilité représentent des coûts de renonciation qui doivent être considérés dans la planification future des services de chirurgie cardiaque, dans le contexte du vieillissement de notre population et de la prévalence croissante de fragilité.
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