Constrictive pericarditis is a rare complication of open heart surgery (OHS), but little is known regarding the etiologic determinants, and prognostic factors. The purpose of this study was to ...investigate clinical predictors and long term prognosis of post-operative constrictive pericarditis (CP).
Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 142,837 patients who were admitted for OHS in New Jersey hospitals between 1995 and 2015. Ninety-one patients were hospitalized with CP 30 days or longer after discharge from OHS. Differences in proportions were analyzed using Chi square tests. Controls were matched to cases for demographics, surgical procedure type, history of OHS, and propensity score. Cox proportional hazard models were used to evaluate the risk of all-cause death. Log-rank tests and Cox models were used to assess differences in the Kaplan-Meier survival curves with and without adjustments for comorbidities.
Patients with CP were more likely to have history of valve disease (VD, p < 0.001), atrial fibrillation (AF, p = 0.024) renal disease (CKD, p = 0.028), hemodialysis (HD, p = 0.008), previous OHS (p < 0.001). Patients with CP compared to matched controls had a higher 7-year mortality (p < 0.001). This difference became statistically significant at 1-year after surgery.
CP is a rare complication of OHS that occurs more frequently in patients with VD, AF, CKD, HD, multiple OHS, and it is associated with an unfavorable long-term prognosis. Given the large number of OHS performed every year, the results highlight the need for clinicians to recognize and properly manage this complication of OHS.
•Constrictive pericarditis after open heart surgery, is a rare complication, albeit with an unfavorable long-term prognosis.•It occurs more frequently in patients with multiple cardiac surgeries, atrial fibrillation, and chronic renal disease.•The number of open heart surgeries yearly highlights the need to recognize and properly manage this complication.•This is the first case-controlled study of patients with constrictive pericarditis after open heart surgery.
Photobiomodulation (PBM) also known as low-level level laser therapy is the use of red and near-infrared light to stimulate healing, relieve pain, and reduce inflammation. The primary chromophores ...have been identified as cytochrome c oxidase in mitochondria, and calcium ion channels (possibly mediated by light absorption by opsins). Secondary effects of photon absorption include increases in ATP, a brief burst of reactive oxygen species, an increase in nitric oxide, and modulation of calcium levels. Tertiary effects include activation of a wide range of transcription factors leading to improved cell survival, increased proliferation and migration, and new protein synthesis. There is a pronounced biphasic dose response whereby low levels of light have stimulating effects, while high levels of light have inhibitory effects. It has been found that PBM can produce ROS in normal cells, but when used in oxidatively stressed cells or in animal models of disease, ROS levels are lowered. PBM is able to up-regulate anti-oxidant defenses and reduce oxidative stress. It was shown that PBM can activate NF-kB in normal quiescent cells, however in activated inflammatory cells, inflammatory markers were decreased. One of the most reproducible effects of PBM is an overall reduction in inflammation, which is particularly important for disorders of the joints, traumatic injuries, lung disorders, and in the brain. PBM has been shown to reduce markers of M1 phenotype in activated macrophages. Many reports have shown reductions in reactive nitrogen species and prostaglandins in various animal models. PBM can reduce inflammation in the brain, abdominal fat, wounds, lungs, spinal cord.
Spring and Autumn Annals of Wu and Yue is the first complete English translation of Wu Yue Chunqiu, a chronicle of two neighboring states during China's Spring and Autumn period. This collection of ...political history, philosophy, and fictional accounts depicts the rise and fall of Wu and Yue and the rivalry between them, the inspiration for centuries of poetry, vernacular fiction, and drama. Wu Yue Chunqiu makes use of rich sources from the past, carefully adapting and developing them into complex stories. Historical figures are transformed into distinctive characters; simple records of events are fleshed out and made tangible. The result is a nuanced record that is both a compelling narrative and a valuable historical text. As one of the earliest examples of a regional history, Wu Yue Chunqiu is also an important source for the history of what is now Zhejiang and Jiangsu. In Spring and Autumn Annals of Wu and Yue, Jianjun He's engaging translation and extensive annotations make this significant historical and literary work accessible to an English-speaking audience for the first time.
The interphase between tendon and bone consists of a highly specialised tissue called enthesis. Typically, the enthesis is described as a succession of four different zones: tendon, non-mineralised ...fibrocartilage, mineralised fibrocartilage and bone. However, the microstructure of the entheses, cellular composition and mechanical properties vary depending on their anatomical location. The present study aimed to characterise three of the most relevant sites of enthesis injury in a rat model: the patellar tendon, the Achilles tendon and the supraspinatus enthesis, in terms of biomechanics, histology and genetic expression. The patellar enthesis presented the highest ultimate load and lowest stiffness of the three, while the supraspinatus was the weakest and stiffest. The histological characterisation revealed key differences at the insertion site for each enthesis. The patellar enthesis showed a large cartilaginous area at the tendon-to-bone interphase whilst this interphase was smaller in the supraspinatus entheses samples. Furthermore, the Achilles tendon enthesis displayed a more abrupt transition from tendon to bone. Additionally, each enthesis exhibited a particular and distinct pattern of expression of tenogenic, chondrogenic and osteogenic markers. This study provided valuable insights for a better understanding of the three entheses at relevant anatomical sites. Moreover, the larger cross-sectional area of the patellar enthesis, the strong mechanical properties and the easier surgical access to this location led to the conclusion that the patellar tendon enthesis site could be most suitable for the development of a preclinical model for general enthesis regeneration studies in rats.
In selective laser melting, the layer-wise local melting of metallic powder by means of a scanning focused laser beam leads to anisotropic microstructures, which reflect the pathway of the laser ...beam. We studied the impact of laser power, scanning speed, and laser path onto the microstructure of NiTi cylinders. Here, we varied the laser power from 56 to 100W and the scanning speed from about 100 to 300mm/s. In increasing the laser power, the grain width and length increased from (33±7) to (90±15) μm and from (60±20) to (600±200) μm, respectively. Also, the grain size distribution changed from uni- to bimodal. Ostwald-ripening of the crystallites explains the distinct bimodal size distributions. Decreasing the scanning speed did not alter the microstructure but led to increased phase transformation temperatures of up to 40K. This was experimentally determined using differential scanning calorimetry and explained as a result of preferential nickel evaporation during the fabrication process. During selective laser melting of the NiTi shape memory alloy, the control of scanning speed allows restricted changes of the transformation temperatures, whereas controlling the laser power and scanning path enables us to tailor the microstructure, i.e. the crystallite shapes and arrangement, the extent of the preferred crystallographic orientation and the grain size distribution.
•Higher laser powers during selective laser melting of NiTi lead to larger grains.•Selective laser melting of NiTi gives rise to preferred orientation.•The observed Ni/Ti ratio depends on the exposure time.•Ostwald ripening explains the bimodal grain size distribution.
The Glory of Yue is the first translation into any Western language of the Yuejue shu, a collection of essays on history, literature, religion, architecture, economic thought, military science, and ...philosophy related to the ancient kingdoms of Wu and Yue, in present day eastern China.
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