Fast-track extubation after modified Fontan procedure Mutsuga, Masato, MD, PhD; Quiñonez, Luis G., MD; Mackie, Andrew S., MD, SM ...
The Journal of thoracic and cardiovascular surgery,
09/2012, Letnik:
144, Številka:
3
Journal Article
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Objective In 2007, we introduced a policy to plan to extubate all patients after a modified Fontan procedure in the operating room. Our objective was to review the feasibility, safety, and clinical ...outcomes of this approach. Methods Patients who underwent a modified Fontan operation between May 2004 and May 2010 were reviewed. Results Ninety-seven patients underwent a modified Fontan operation (mean age, 3.9 ± 2.2 years; mean weight, 15.1 ± 5.0 kg); 46 patients (47%) were extubated in the operating room (group A). Nineteen patients were extubated in the intensive care unit within 24 hours (group B), and 32 patients had delayed extubation (group C). The 3 groups were not significantly different with respect to preoperative characteristics. Twenty-four hours postoperatively, group A had a lower mean central venous pressure compared with patients in group B or C (13 vs 14 vs 17 mm Hg, respectively, P < .001); a higher base excess (0.4 vs −1.3 vs −3.4, P < .001); a lower fluid balance (234 vs 514 vs 730 mL, P < .001); and a lower inotrope score (4.6 vs 6.7 vs 10.8, P < .001). Group C had a longer median intensive care unit length of stay (2 vs 3 vs 6 nights, P = .01), kept their chest tubes longer (8 vs 9 vs 15 days, P = .001), and had a longer median hospital length of stay (9 vs 11 vs 21 days, P = .001). Conclusions Extubation in the operating room after a modified Fontan procedure seems feasible. This approach is associated with improved early postoperative hemodynamics, earlier time to chest tube removal, and shorter intensive care unit and hospital lengths of stay.
The interrelationship between mood disorders and borderline personality disorder (BPD) has been long debated in the literature. Increasing attention has also been paid to the relationship between ...posttraumatic stress disorder (PTSD) and BPD, as well as to the role of rumination in the development and severity of BPD. This study aims to evaluate the association of rumination, PTSD, and mood spectrum among patients with BPD with or without comorbid mood disorders.
Fifty patients with BPD and 69 healthy controls were assessed with the Structured Clinical Interview for the
5, Mood Spectrum Self-Report (MOODS-SR), and Ruminative Response Scale (RRS).
The BPD group was split into subjects with BPD+ mood disorder (MD) or BPD only) . PTSD-criteria fulfillment, MOODS, and RRS scores were significantly higher in both BPD subgroups than in controls, while BPD+MD patients scored significantly higher than the BPD-only group. RRS scores and PTSD-criteria fulfillment were significantly related to the presence of both BPD and BPD+MD, with no effect of MOODS-SR scores.
Our findings confirm the presence of a relationship between BPD and the PTSD spectrum, highlighting also a possible role of rumination in BPD psychopathology. Rumination and PTSD symptoms seem to prevail in the effect of mood spectrum in predicting BPD.
Pharyngeal-provocation induced aerodigestive symptoms in infants remain an enigma. Sources of pharyngeal provocation can be anterograde as with feeding, and retrograde as in gastroesophageal reflux. ...We determined maturational and dose–response effects of targeted pharyngeal-stimulus on frequency, stability, and magnitude of pharyngeal and respiratory waveforms during multiple pharyngeal swallowing responses in preterm-born infants when they were of full-term postmenstrual age (PMA). Eighteen infants (11 male) were studied longitudinally at 39.8 ± 4.8 weeks PMA (time-1) and 44.1 ± 5.8 weeks PMA (time-2). Infants underwent concurrent pharyngo-esophageal manometry, respiratory inductance plethysmography, and nasal airflow thermistor methods to test sensory-motor interactions between the pharynx, esophagus, and airway. Linear mixed models were used and data presented as mean ± SEM or %. Overall, responses to 250 stimuli were analyzed. Of the multiple pharyngeal swallowing responses (
n
= 160), with maturation (a) deglutition apnea duration decreases (
p
< 0.01), (b) number of pharyngeal waveform peaks and duration decreases for initial responses (
p
< 0.01), and subsequent responses have lesser variation and greater stability (
p
< 0.01). With increment in stimulus volumes we noted (a) increased prevalence (%) of pharyngeal responses (
p
< 0.05), (b) increased number of pharyngeal peaks (
p
< 0.05), yet pharyngeal frequency (Hz), variability, and stability remain unaffected (
p
> 0.05), and (c) respiratory changes were unaffected (
p
> 0.05). Initial and subsequent pharyngeal responses and respiratory rhythm interactions become more distinct with maturation. Interval oromotor experiences and volume-dependent increase in adaptive responses may be contributory. These mechanisms may be important in modulating and restoring respiratory rhythm normalcy.
Background
Reduction in the incidence of surgical site infection (SSI) serves as a measure of patient safety and quality improvement. Cesarean birth (CB) accounts for 31.9% of all childbirths in the ...United States. However, our understanding of SSI prevention bundles predominantly stems from gynecological and colorectal surgeries. This study aimed to determine the efficacy of a standardized perioperative bundle designed to reduce SSI in CBs.
Methods
All CB patients at Flushing Hospital Medical Center from 2017 to 2019 were included in a retrospective analysis. Patients were divided into three groups based on the timing of intervention: prebundle/control, transition, and postbundle. Baseline demographics and clinical characteristics were summarized using descriptive statistics. Multiple logistic regression was performed to determine the association between bundle group and SSI, considering variables different between groups at baseline (P < 0.10).
Results
Two thousand eight hundred and seventy‐five CBs were performed: 1086 in prebundle, 812 in transition, and 977 in postbundle phase. In the prebundle phase, 25 CBs (2.3%) were complicated by SSIs; in the transition phase, 10 (1.2%) had SSIs; and in the postbundle phase, 7 (0.7%; P = 0.009) had SSIs. In a logistic regression model, only use of the CB bundle (OR 0.26 95% CI 0.07‐0.94; P = 0.04), rupture of membranes (0.29 0.09‐0.87; P = 0.03), and operating room time (1.02 1.01‐1.04; P = 0.01) were significant in prediction of SSI. SSI postbundle was significantly reduced from prebundle (0.04).
Conclusions
Thus, introduction of a hospital‐wide perioperative bundle significantly reduced SSI rates, and should be developed as a mainstay of CB surgical care.
Many viruses, beside binding to their main cell target, interact with other molecules that promote virus adhesion to the cell; often, these additional targets are glycans. The main receptor for ...SARS-CoV-2 is a peptide motif in the ACE2 protein. We studied interaction of the recombinant SARS-CoV-2 spike (S) protein with an array of glycoconjugates, including various sialylated, sulfated, and other glycans, and found that the S protein binds some (but not all) glycans of the lactosamine family. We suggest that parallel influenza infection will promote SARS-CoV-2 adhesion to the respiratory epithelial cells due to the unmasking of lactosamine chains by the influenza virus neuraminidase.
The aim of this study was to determine the discriminative value of irisin for acutely decompensated heart failure (ADHF) in type 2 diabetes mellitus (T2DM) patients with chronic HF. We included 480 ...T2DM patients with any phenotype of HF and followed them for 52 weeks. Hemodynamic performances and the serum levels of biomarkers were detected at the study entry. The primary clinical end-point was ADHF that led to urgent hospitalization. We found that the serum levels of N-terminal natriuretic pro-peptide (NT-proBNP) were higher (1719 980-2457 pmol/mL vs. 1057 570-2607 pmol/mL, respectively) and the levels of irisin were lower (4.96 3.14-6.85 ng/mL vs. 7.95 5.73-9.16 ng/mL) in ADHF patients than in those without ADHF. The ROC curve analysis showed that the estimated cut-off point for serum irisin levels (ADHF versus non-ADHF) was 7.85 ng/mL (area under curve AUC = 0.869 (95% CI = 0.800-0.937), sensitivity = 82.7%, specificity = 73.5%;
= 0.0001). The multivariate logistic regression yielded that the serum levels of irisin < 7.85 ng/mL (OR = 1.20;
= 0.001) and NT-proBNP > 1215 pmol/mL (OR = 1.18;
= 0.001) retained the predictors for ADHF. Kaplan-Meier plots showed a significant difference of clinical end-point accumulations in patients with HF depending on irisin levels (<7.85 ng/mL versus ≥7.85 ng/mL). In conclusion, we established that decreased levels of irisin were associated with ADHF presentation in chronic HF patients with T2DM independently from NT-proBNP.
While hybridization and introgression can have a strong adaptive importance, it can impede divergence of species.
Quercus magnoliifolia
and
Q. resinosa
are two endemic oak species distributed across ...the Mexican highlands. These species diverged ecological and morphologically; however, no nuclear genetic differentiation is evident. In this study, we determined the mechanisms that shape patterns of genetic variation and establish the role of migration and hybridization in the evolutionary history of these two oak species. To do this, Bayesian approaches were used for inference on migration rates and directionality and timing of divergence between species using chloroplast microsatellites. We then integrated species distribution models to infer the geographic distribution of
Q. magnoliifolia
and
Q. resinosa
during Last Interglacial, Last Glacial Maximum, and Mid-Holocene time frames. We failed in distinguishing a unique genetic composition for each species. Chloroplast differentiation was more congruent with geography than the taxonomic status of each species. Our study revealed that after the divergence (
c
. 10 Mya) of these two oak species, high rates of introgression took place at the end of the Pleistocene. Furthermore, past distribution models predicted that
Q. magnoliifolia
and
Q. resinosa
have likely been in sympatry presumable since Last Glacial Maximum and
Q. resinosa
probably expanded geographically towards its current distribution around Mid-Holocene. This expansion was supported by testing migration models, suggesting recent establishment of
Q. resinosa
to the north of Trans-Mexican Volcanic Belt. We hypothesized that after
Q. magnoliifolia
and
Q. resinosa
diverged, colonization events followed by hybridization between oaks and long-distance seed dispersal occurred, explaining the present-day patterns of distribution of chloroplast diversity. We propose that divergence of species remains mainly on loci under natural selection, providing evidence on the “porous” nature of species boundaries among oaks.
This work investigated in vitro aggregation and amyloid properties of skeletal myosin binding protein-C (sMyBP-C) interacting in vivo with proteins of thick and thin filaments in the sarcomeric ...A-disc. Dynamic light scattering (DLS) and transmission electron microscopy (TEM) found a rapid (5-10 min) formation of large (>2 μm) aggregates. sMyBP-C oligomers formed both at the initial 5-10 min and after 16 h of aggregation. Small angle X-ray scattering (SAXS) and DLS revealed sMyBP-C oligomers to consist of 7-10 monomers. TEM and atomic force microscopy (AFM) showed sMyBP-C to form amorphous aggregates (and, to a lesser degree, fibrillar structures) exhibiting no toxicity on cell culture. X-ray diffraction of sMyBP-C aggregates registered reflections attributed to a cross-β quaternary structure. Circular dichroism (CD) showed the formation of the amyloid-like structure to occur without changes in the sMyBP-C secondary structure. The obtained results indicating a high in vitro aggregability of sMyBP-C are, apparently, a consequence of structural features of the domain organization of proteins of this family. Formation of pathological amyloid or amyloid-like sMyBP-C aggregates in vivo is little probable due to amino-acid sequence low identity (<26%), alternating ordered/disordered regions in the protein molecule, and S-S bonds providing for general stability.
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