Evaluating Cardiac Surgery Outcomes in the Context of a High-Risk Patient Population and its Implications for the Training of Future Surgeons

Our dissertation evaluated the outcomes of cardiac surgery in the context of an increasingly high-risk patient cohort. It demonstrated the utility of clinical registries and risk-assessment tools in optimizing outcomes of high-risk patients. These tools have allowed comparative analyses to be performed which have demonstrated the safety and efficacy of novel surgical techniques in high-risk patients. Our dissertation also established the increased risk of early and mid-term mortality associated with AF across a spectrum of cardiac surgery procedures. There are two major implications of this finding. Firstly, AF warrants consideration as an independent risk factor in future risk stratification tools. Secondly, surgeons should consider treating AF at the time of cardiac surgery with a concomitant AF surgery procedure. The safety and efficacy of this procedure has been demonstrated in many studies but it is currently underutilized. Finally, we demonstrated the safety and efficacy of cardiac surgery performed by trainee surgeons. This is a relevant finding in the contemporary era where surgeons may be reluctant to provide training opportunities to junior surgeons because of the increased scrutiny on outcomes and the perception of increased risk. Our data demonstrated that properly supervised trainees achieve equivalent outcomes to their consultant peers. Nevertheless, given the gradual shift of cardiac surgery into a specialty which incorporates more minimally invasive procedures and percutaneous interventions, there is an urgent need to train surgeons in these approaches. Moreover, the training deficit in AF surgery needs to be rectified. These actions will ensure that the future generation of cardiac surgeons is trained to deal with the increasingly high-risk patient cohort that they will encounter

Health-related quality of life following lung transplantation for cystic fibrosis: A systematic review

Background: Lung transplantation represents the definite treatment for CF patients with advanced-stage pulmonary disease. Recent major developments in the treatment of CF indicate the need for an evaluation of lung transplantation as the current best practice in end-stage disease. This systematic review was performed to evaluate the impact of lung transplantation on health-related quality of life in patients with CF. Methods: PubMed was searched for studies matching the eligibility criteria between January 2000 and January 2022. OVID (MEDLINE), Google Scholar, and EBSCOhost (EMBASE) as well as bibliographies of included studies were also reviewed. Applying predetermined eligibility criteria, the included studies were selected. Predetermined forms were used to conduct a quality appraisal and implement data tabulation. Results were synthesized by narrative review. This systematic review was prospectively registered in the PROSPERO register (CRD 42022341942). Results: Ten studies (1494 patients) were included. Lung transplantation results in improvements in HRQoL in CF patients relative to their baseline waitlisted state. Up to five years postoperatively CF patients retain their HRQoL at levels similar to the general population. There are several modulating factors that impact HRQoL outcomes in CF patients post-LTx. Compared to lung recipients with other diagnoses CF patients achieve either greater or equal levels of HRQoL. Conclusion: Lung transplantation conveys improved HRQoL to CF patients with the advanced-stage pulmonary disease for up to five years, and to levels comparable to the general population and non-waitlisted CF patients. This systematic review quantifies, using current evidence, the improvements in HRQoL gained by CF patients following lung transplantation

Route Planning Using Nature-Inspired Algorithms

There are many different heuristic algorithms for solving combinatorial optimization problems that are commonly described as Nature-Inspired Algorithms (NIAs). Generally, they are inspired by some natural phenomenon, and due to their inherent converging and stochastic nature, they are known to give optimal results when compared to classical approaches. There are a large number of applications of NIAs, perhaps the most popular being route planning problems in robotics - problems that require a sequence of translation and rotation steps from the start to the goal in an optimized manner while avoiding obstacles in the environment. In this chapter, we will first give an overview of Nature-Inspired Algorithms, followed by their classification and common examples. We will then discuss how the NIAs have applied to solve the route planning problem.Comment: This work is part of 'High-Performance Vision Intelligence'; Part of the Studies in Computational Intelligence book series (SCI,volume 913) and can be accessed at: https://link.springer.com/chapter/10.1007/978-981-15-6844-2_1

Predictive modeling of brain tumor: A Deep learning approach

Image processing concepts can visualize the different anatomy structure of the human body. Recent advancements in the field of deep learning have made it possible to detect the growth of cancerous tissue just by a patient's brain Magnetic Resonance Imaging (MRI) scans. These methods require very high accuracy and meager false negative rates to be of any practical use. This paper presents a Convolutional Neural Network (CNN) based transfer learning approach to classify the brain MRI scans into two classes using three pre-trained models. The performances of these models are compared with each other. Experimental results show that the Resnet-50 model achieves the highest accuracy and least false negative rates as 95% and zero respectively. It is followed by VGG-16 and Inception-V3 model with an accuracy of 90% and 55% respectively.Comment: 5 pages, 9 figures, Published in Innovations in Computational Intelligence and Computer Vision (ICICV-2020), Springer and will be appear in Scopus Indexed Springer Book Series Advances in Intelligent Systems and Computing ISSN: 2194-535

A Critical evaluation of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis

Background: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with colorectal peritoneal carcinomatosis (CRPC). This treatment modality is associated with relatively high rates of perioperative morbidity and mortality. This study evaluated the clinical and treatment-related risk factors for perioperative morbidity and mortality in patients with CRPC who underwent CRS and PIC. Methods: Sixty-three consecutive patients who underwent CRS and PIC for CRPC were evaluated. Adverse events were rated from grades I to V with increasing severity. Clinical and treatment-related risk factors for grades III and IV/V morbidity were determined. Results: There were no perioperative deaths (0%). The grades III and IV morbidity rates were 14 and 17%, respectively. A peritoneal cancer index >12 (p = 0.019), transfusion >4 units (p = 0.028), number of peritonectomy procedures >3 (p = 0.013), left upper quadrant peritonectomy procedure (p 1 (p = 0.004) were associated with grade IV morbidity on univariate analysis. Only left upper quadrant procedure was associated with grade IV morbidity on multivariate analysis (p = 0.002). Only number of primary colonic anastomosis >1 (p = 0.037) was associated with grade III morbidity on univariate analysis. This also was associated with grade III morbidity on multivariate analysis (p = 0.028). Conclusions: CRS and PIC has an acceptable risk of perioperative morbidity in carefully selected patients with CRPC. Patients who require extensive surgery have the highest risk for a severe adverse event. Preoperative evaluation of patients is essential to improve perioperative outcome.9 page(s

Critical assessment of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei

Background: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%. This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC. Materials and Methods: A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis. Results: The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: Peritoneal cancer index ≥21 (P = .034), ASA score ?3 (P = .003), operation duration ≥10 h (P < .001), left upper quadrant peritonectomy procedure (P = .037), colonic resection (P = .012), ostomy (P = .005), ileostomy (P = .012), and transfusion ≥6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA ≥ 3 (P = .006) and an operation length ≥10 h (P < .001). Conclusions: CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.11 page(s

Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? : a systematic review of morbidity and mortality

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been offered in many institutions worldwide since the 1990s. Despite its existence of more than 10 years, this treatment has received heavy criticism for its morbidity and mortality rates. This consequentially resulted in a lack of randomized trials being conducted and translates into a lack of the most reliable form of scientific evidence in clinical research, hence limiting its general acceptance. OBJECTIVE:: To report the morbidity and mortality outcomes of CRS and HIPEC from all institutions performing this treatment as a prelude toward establishing the safety of this treatment for peritoneal carcinomatosis. METHODS:: A systematic review of relevant studies before August 2008 was performed. Each study was appraised using a predetermined protocol. The quality of studies was assessed. The morbidity and mortality of the treatment were synthesized through a narrative review with full tabulation of results of all included studies. CONCLUSIONS:: The morbidity and mortality outcomes of CRS and HIPEC are similar to a major gastrointestinal surgery, such as a Whipple's procedure. To derive the maximal benefit of this treatment, careful patient selection with an optimal level of postoperative care must be advocated to avoid undesirable complications of this treatment.8 page(s

Postoperative pancreatic fistula after cytoreductive surgery and perioperative intraperitoneal chemotherapy : incidence, risk factors, management, and clinical sequelae

Background: Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has improved survival in selected patients with peritoneal carcinomatosis. This study evaluates the morbidity of postoperative pancreatic fistula (PF) within the context of CRS and PIC. Methods: Two hundred seventy-one consecutive CRS and PIC procedures were evaluated. Diagnosis and classification of postoperative PF were performed according to the international study group on PF criteria. The associations between 8 clinical and 20 treatment-related factors with postoperative PF were determined by univariate and multivariate analysis. The management and clinical sequelae of postoperative PF were discussed. Results: Seventeen patients (6.3%) developed postoperative PF. None of these patients died during their in-hospital stay. Multivariate analysis identified three independent risk factors for PF: Transfusion of ?6 units of blood (P = 0.029), operation duration of ?9 h (P = 0.035), and splenectomy (P = 0.020). Conservative management of PF was instituted in all 17 patients and was successful in 16 (94%). The overall time to PF closure was 26 (standard deviation 16) days after diagnosis. Although PF did not contribute to procedure-related mortality, it was associated with increased length of hospital stay (P < 0.001). Conclusions: CRS and PIC presented an acceptable rate of PF that did not increase the procedure-related mortality. However, PF was associated with longer hospital stay. Most patients with PF were treated conservatively and did not require surgical intervention.9 page(s