Objective:
To evaluate the effects of intrathecal morphine (ITM) on the perioperative use of opiates and the fast-track pathway in patients undergoing minimally invasive direct coronary artery bypass ...grafting (MIDCAB).
Design:
Retrospective cohort study.
Settings:
University teaching hospital.
Participants:
Twenty-two elective consecutive patients who underwent MIDCAB surgery.
Interventions:
Eleven patients received an intrathecal injection of morphine, 7 μg/kg (ITM group, n = 11), and the control group (n = 11) received standard anesthesia care.
Measurements and Main Results:
The intraoperative dose of fentanyl was 0.55 ± 0.2 mg in the ITM group and 1.1 ± 0.2 mg in the control group (
p < 0.0001). Four patients in the ITM group and none in the control group were extubated in the operating room. Extubation time was 3.2 ± 4.7 hours in the ITM group and 6.3 ± 3.4 hours in the control group (
p = 0.016). Morphine requirements in 24 hours after surgery were 2.0 ± 3.5 mg in the ITM and 16.1 ± 4.8 mg in the control group (
p < 0.0001). There were no differences in ischemic time, intraoperative fluid requirements, postoperative blood loss, and duration of surgical procedure. Hospital length of stay was shorter in the ITM group compared with the control group (3.9 ± 1.7 days
v 4.9 ± 1.4 days, respectively,
p = 0.047).
Conclusions:
ITM has to be considered in MIDCAB surgery as an effective component of the perioperative analgesia. The safety and effects of ITM in the patient’s recovery after MIDCAB surgery should be evaluated in further prospective studies.
The past few decades have witnessed an array of advances in DNA science including the introduction of genomics and bioinformatics. The quest for complete genome sequences has driven the development ...of microarray and massively parallel sequencing technologies at a rapid pace, yielding numerous scientific discoveries. My thesis applies several of these genome-scale technologies to understand genomic response to perturbation as well as chromatin structure, and it is divided into three major studies. The first study describes a method I developed to identify drug targets by overexpressing human genes in yeast. This chemical genomic assay makes use of the human ORFeome collection and oligonucleotide microarrays to identify potential novel human drug targets. My second study applies genome resequencing of yeast that have evolved resistance to antifungal drug combinations. Using massively parallel genomic sequencing, I identified novel genomic variations that were responsible for this resistance and it was confirmed in vivo. Lastly, I report the characterization of chromatin structure in a non-eukaryotic species, an archaeon. The conservation of the nucleosomal landscape in archaea suggests that chromatin is not solely a hallmark of eukaryotes, and that its role in transcriptional regulation is ancient. Together, these 3 studies illustrate how maturation of genomic technology for research applications has great utility for the identification of potential human and antifungal drug targets and offers an encompassing glance at the structure of genomes.
The incidence of systemic air embolism during cardiopulmonary bypass is estimated to be 0.1%. However, the vast majority of instances are unreported and quietly ignored. The result may be disability ...or death. The control of air embolism obviously lies in prevention. The definite and specific treatment of this complication is hyperbaric oxygen. We report 6 patients referred to our institute because of air embolism during cardiopulmonary bypass. Of the 4 patients in whom hyperbaric oxygen therapy was delayed for 17 to 20 hours, 2 showed partial neurological improvement, as opposed to the success of hyperbaric oxygen therapy in the 2 patients in whom the delay was minimal. We conclude that as soon as the proposed open heart operation has been completed and there is an indication that air embolism has occurred, the patient should be treated with hyperbaric oxygen as quickly as possible, even before neurologic manifestations of cerebral ischemia appear.
Starch-formate/glycerol compound fibers, processed into nonwoven mat using coaxial electrospinning technique. Neat core-sheath morphology of the fibers was obtained, successfully encapsulating ...lactobacillus paracasei strains as a model biotherapeutic product.
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•Starch fibers loaded with cells were successfully fabricated using coaxial electrospinning.•Starch-formate/glycerol interactions with time.•Spinnabillity of starch.•Coaxially electrospun starch fibers offer a versatile encapsulation platform for of biotherapeutics.•Encapsulated cells stability.
Effective encapsulation and protection of biotherapeutics using a bio-based carrier, preferably issued from renewable resources, remains a challenge. Herein, we demonstrate application of coaxial electrospinning to fabric starch-based core-sheath compound fibers as a bacterial cells’ carrier. Starch-formate is employed as an encapsulation agent, while the fiber core is made of glycerol, serving as a cell suspension medium. SEM microscopy reveals a distinct core-sheath morphology of the starch-formate/glycerol (SFG) compound fibers with mean diameters of 4.13±1.05μm. Calorimetric and thermomechanical analyses and FTIR spectroscopy show a progressive interaction between the starch-formate and the glycerol with time, pronounced with temperature increase. SFG fibers with encapsulated Lactobacillus paracasei are proved stable with retained bacterial viability when stored at 4°C and room temperature for up to 21days. SFG fibers present a potential biotherapeutic products’ encapsulation platform, guaranteeing the stability at refrigerated and ambient storage conditions, as determined in this study.
Objectives This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging ...together with coronary computed tomography angiography (CTA). Background Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans. Methods Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers. Results The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 ± 10.7 years; 82% male; body mass index 30.4 ± 5 kg/m2 ) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis ≥50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with ≥50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis ≥70%. Conclusions Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.
Objectives In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals. Background ...Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events. Methods We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC. Results A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome. Conclusions On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.
Achieving the objectives of sustainable development in water and agri-food systems requires the utilisation of decision-support tools in stakeholder-driven processes to construct and simulate various ...scenarios and evaluate the outcomes of associated policy interventions. While it is common practice to involve stakeholders in participatory modelling processes, their comprehensive documentation and the lessons learned remain scarce. In this paper, we share our experience of engaging stakeholders throughout the entire system dynamics modelling process. We draw on two projects implemented in the Volta River Basin, West Africa, to understand the dynamics of water and agri-food systems under changing environmental and socioeconomic conditions. We outline eight key insights and lessons as practical guides derived from each stage of the participatory modelling process, including the pre-workshop stage, problem definition, model conceptualization, simulation model formulation, model testing and verification, and policy design and evaluation. Our findings demonstrate that stakeholders can actively contribute to all phases of the system dynamics modelling process, including parameter estimation, sensitivity analysis, and numerical simulation experiments. However, we encountered notable challenges, including the time-intensive nature of the process, the struggle to reach a consensus on the modelled problem, and the difficulty of translating the conceptual model into a simulation model using stock and flow diagrams – all of which were addressed through a structured facilitation process. While the projects were anchored in the specific context of West Africa, the key lessons and insights highlighted have broader significance, particularly for researchers employing PSDM in regions characterised by multifaceted human-environmental systems and where stakeholder involvement is crucial for holistic understanding and effective policy interventions. This paper contributes practical guidance for future efforts with participatory modelling, particularly in regions worldwide grappling with sustainable development challenges in water and agri-food systems, and where stakeholder involvement is crucial for holistic understanding of the multiple challenges and for designing effective policy interventions.
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