Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies

Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG

Probing Supersymmetry With Third-Generation Cascade Decays

The chiral structure of supersymmetric particle couplings involving third generation Standard Model fermions depends on left-right squark and slepton mixings as well as gaugino-higgsino mixings. The shapes and intercorrelations of invariant mass distributions of a first or second generation lepton with bottoms and taus arising from adjacent branches of SUSY cascade decays are shown to be a sensitive probe of this chiral structure. All possible cascade decays that can give rise to such correlations within the MSSM are considered. For bottom-lepton correlations the distinctive structure of the invariant mass distributions distinguishes between decays originating from stop or sbottom squarks through either an intermediate chargino or neutralino. For decay through a chargino the spins of the stop and chargino are established by the form of the distribution. When the bottom charge is signed through soft muon tagging, the structure of the same-sign and opposite-sign invariant mass distributions depends on a set function of left-right and gaugino-higgsino mixings, as well as establishes the spins of all the superpartners in the sequential two-body cascade decay. Tau-lepton and tau-tau invariant mass distributions arising from MSSM cascade decays are likewise systematically considered with particular attention to their dependence on tau polarization. All possible tau-lepton and tau-tau distributions are plotted using a semi-analytic model for hadronic one-prong taus. Algorithms for fitting tau-tau and tau-lepton distributions to data are suggested.Comment: 35 pages, 17 .eps figure

Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years

Background Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. Results We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. Conclusions Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use

Higher-order ratios of baryon number cumulants

The relevance of higher order cumulants of net baryon number fluctuations for the analysis of freeze-out and critical conditions in heavy-ion collisions at LHC and RHIC is addressed. The sign structure of the higher order cumulants in the vicinity of the chiral crossover temperature might be a sensitive probe and may allow to elucidate their relation to the QCD phase transition. We calculate ratios of generalized quark-number susceptibilities to high orders in three flavor QCD-like models and investigate their sign structure close to the chiral crossover line.Comment: presented at the International Conference "Critical Point and Onset of Deconfinement - CPOD 2011", Wuhan, November 7-11, 2011; version to appear in Cent. Eur. J. Phy

Testing Gluino Spin with Three-Body Decays

We examine the possibility of distinguishing a supersymmetric gluino from a Kaluza-Klein gluon of universal extra dimensions (UED) at the Large Hadron Collider (LHC). We focus on the case when all kinematically allowed tree-level decays of this particle are 3-body decays into two jets and a massive daughter (typically weak gaugino or Kaluza-Klein weak gauge boson). We show that the shapes of the dijet invariant mass distributions differ significantly in the two models, as long as the mass of the decaying particle mA is substantially larger than the mass of the massive daughter mB. We present a simple analysis estimating the number of events needed to distinguish between the two models under idealized conditions. For example, for mA/mB=10, we find the required number of events to be of order several thousand, which should be available at the LHC within a few years. This conclusion is confirmed by a parton level Monte Carlo study which includes the effects of experimental cuts and the combinatoric background.Comment: 19 pages, 10 figure

Influence of Body Mass Index on outcomes after minimal-access aortic valve replacement through a J-shaped partial upper sternotomy

BACKGROUND: Minimal-access aortic valve replacement (MAAVR) may reduce post-operative blood loss and transfusion requirements, decrease post-operative pain, shorten length stay and enhance cosmesis. This may be particularly advantageous in overweight/obese patients, who are at increased risk of post-operative complications. Obese patients are however often denied MAAVR due to the perceived technical procedural difficulty. This retrospective analysis sought to determine the effect of BMI on post-operative outcomes in patients undergoing MAAVR. METHODS: Ninety isolated elective MAAVR procedures performed between May 2006–October 2013 were included. Intra- and post-operative data were prospectively collected. Ordinary least squares univariate linear regression analysis was performed to determine the effect of BMI as a continuous variable on post-operative outcomes. One-way ANOVA and Chi-squared testing was used to assess differences in outcomes between patients with BMI <25 (n = 36) and BMI ≥25 (n = 54) as appropriate. RESULTS: There was no peri-operative mortality, myocardial infarction or stroke. Univariate regression demonstrated longer cross-clamp times (p = 0.0218) and a trend towards increased bypass times (p = 0.0615) in patients with higher BMI. BMI ≥25 was associated with an increased incidence of hospital-acquired pneumonia (p = 0.020) and new-onset atrial fibrillation (p = 0.036) compared to BMI <25. However, raised BMI did not extend ICU (p = 0.3310) or overall hospital stay (p = 0.2614). Similar rates of sternal wound complications, inotrope requirements and renal dysfunction were observed in both normal- and overweight/obese-BMI groups. Furthermore, increasing BMI correlated with reduced mechanical ventilation time (p = 0.039) and early post-operative blood loss (p = 0.004). CONCLUSIONS: Our results demonstrate that within the range of this study, MAAVR is a safe, reproducible and effective procedure, affording equivalent clinical outcomes in both overweight/obese and normal-weight patients considered for an isolated first-time AVR, with low post-operative morbidity and mortality. MAAVR should therefore be considered as an alternative surgical strategy to reduce obesity-related complications in patients requiring aortic valve replacement

The mechanical and material properties of elderly human articular cartilage subject to impact and slow loading

Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.Peer reviewedPostprin

Impact testing to determine the mechanical properties of articular cartilage in isolation and on bone

The original publication is available at www.springerlink.comNon peer reviewedPostprin

Spin Discrimination in Three-Body Decays

The identification of the correct model for physics beyond the Standard Model requires the determination of the spin of new particles. We investigate to which extent the spin of a new particle $X$ can be identified in scenarios where it decays dominantly in three-body decays $X\to f\bar{f} Y$. Here we assume that $Y$ is a candidate for dark matter and escapes direct detection at a high energy collider such as the LHC. We show that in the case that all intermediate particles are heavy, one can get information on the spins of $X$ and $Y$ at the LHC by exploiting the invariant mass distribution of the two standard model fermions. We develop a model-independent strategy to determine the spins without prior knowledge of the unknown couplings and test it in a series of Monte Carlo studies.Comment: 31+1 pages, 4 figures, 8 tables, JHEP.cls include

Multiscale - Patient-Specific Artery and Atherogenesis Models

In this work, we present a platform for the development of multiscale patient-specific artery and atherogenesis models. The platform, called ARTool, integrates technologies of 3-D image reconstruction from various image modalities, blood flow and biological models of mass transfer, plaque characterization, and plaque growth. Patient images are acquired for the development of the 3-D model of the patient specific arteries. Then, blood flow ismodeled within the arterial models for the calculation of the wall shear stress distribution (WSS). WSS is combined with other patient-specific parameters for the development of the plaque progression models. Real-time simulation can be performed for same cases in grid environment. The platform is evaluated using both animal and human data