The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization

Objective: To determine the relative risk of sternal dehiscence in patients undergoing bilateral internal thoracic artery harvesting and to assess whether and to what extent the technique of artery skeletonization might reduce this risk. Methods: Prospectively collected data on patients undergoing coronary artery bypass operations with at least a single internal thoracic artery were reviewed. The last 450 patients receiving bilateral internal thoracic artery grafts were compared with 450 patients who received a single internal thoracic artery during the same period. The left internal thoracic artery was always harvested in a pedicled fashion. Among patients receiving a bilateral internal thoracic artery, both arteries were harvested in a pedicled fashion in 300 cases, whereas both internal thoracic arteries were skeletonized in the remaining 150 cases. Results: Compared with a single internal thoracic artery, harvesting both internal thoracic arteries either in a skeletonized or in a pedicled fashion increased the chance of deep (1.1% vs 3.3% vs 4.7%; P =. 01) or superficial (4.8% vs 7.8% vs 12%; P =. 002) sternal infection. However, the technique of artery harvesting (odds ratio, 4.1; 95% confidence interval, 1.4-12.1); the presence of peripheral arteriopathy (odds ratio, 3.1; 95% confidence interval, 1.2-8.5), and resternotomy for bleeding (odds ratio, 8.2; 95% confidence interval, 2.0-33.6) were the only independent predictors for deep sternal infection, whereas the technique of artery harvesting (odds ratio, 3.0; 95% confidence interval, 1.6-5.4), female sex (odds ratio, 2.2; 95% confidence interval, 1.2-4.2), and diabetes (odds ratio, 1.7; 95% confidence interval, 1.0-2.9) were the only independent predictors of superficial sternal infection. In diabetic patients, there was no difference in the incidence of deep sternal infection among patients receiving a single internal thoracic artery or double skeletonized internal thoracic arteries (P =. 4). Conclusions: Bilateral internal thoracic artery harvesting carries a higher risk of sternal infection than harvesting a single internal thoracic artery. Skeletonization of both internal thoracic arteries significantly decreases this risk. A strategy of bilateral thoracic artery grafting can also be offered to patients at high risk for wound infection. Copyright © 2005 by The American Association for Thoracic Surgery

The immune landscape of thyroid cancer in the context of immune checkpoint inhibition

Immune cells play critical roles in tumor prevention as well as initiation and progression. However, immune-resistant cancer cells can evade the immune system and proceed to form tumors. The normal microenvironment (immune cells, fibroblasts, blood and lymphatic vessels, and interstitial extracellular matrix (ECM)) maintains tissue homeostasis and prevents tumor initiation. Inflammatory mediators, reactive oxygen species, cytokines, and chemokines from an altered microenvironment promote tumor growth. During the last decade, thyroid cancer, the most frequent cancer of the endocrine system, has emerged as the fifth most incident cancer in the United States (USA), and its incidence is steadily growing. Inflammation has long been associated with thyroid cancer, raising critical questions about the role of immune cells in its pathogenesis. A plethora of immune cells and their mediators are present in the thyroid cancer ecosystem. Monoclonal antibodies (mAbs) targeting immune checkpoints, such as mAbs anti-cytotoxic T lymphocyte antigen 4 (anti-CTLA-4) and anti-programmed cell death protein-1/programmed cell death ligand-1 (anti-PD-1/PD-L1), have revolutionized the treatment of many malignancies, but they induce thyroid dysfunction in up to 10% of patients, presumably by enhancing autoimmunity. Combination strategies involving immune checkpoint inhibitors (ICIs) with tyrosine kinase (TK) or serine/threonine protein kinase B-raf (BRAF) inhibitors are showing considerable promise in the treatment of advanced thyroid cancer. This review illustrates how different immune cells contribute to thyroid cancer development and the rationale for the antitumor effects of ICIs in combination with BRAF/TK inhibitors

SAS multipass interferometry for monitoring seabed deformation using a high-frequency imaging sonar

Abstract-. This paper presents the results of a two years project led and funded by Eni from 2008 to 2010 with the aim of supporting the development and experimentation of innovative technology for environmental monitoring. The problem addressed is the precise estimate of possible altimetric variations of the seabed through long-term monitoring. The selected methodology consists in the application of repeat-track interferometry to high-resolution, high-frequency sonar data collected from an AUV during repeated surveys of a seafloor area of interest. The paper describes the experimental measurements conducted at sea, the SAS and interferometry methodologies developed, and the results obtained on artificial objects sitting on the seabed. The quality of the achieved focusing is analyzed. The achieved repeat-pass SAS interferograms are shown and analyzed. The coherence along time of the particular kind of seabed (silty sand) characterizing the experimental area is presented and the utility of artificial reflectors for long-term SAS interferometry is discussed.Published673-6832.5. Laboratorio per lo sviluppo di sistemi di rilevamento sottomariniN/A or not JCRreserve

A Methodical Approach for Pcb Pdn Decoupling Minimizing overdesign with Genetic Algorithm Optimization

An optimization routine is applied for the decoupling capacitor placement on Power Distribution Networks to identify the limit beyond which the placement of additional decaps is no longer effective, thus leading to wasting layout area and components, and to a cost increase. A specific test example from a real design is used together with the required target impedance and frequency band of interest for the PDN design. The effectiveness of the decap placement while selecting different layers of the stack-up, and while moving the upper limit of the PDN design band is analyzed. Such analysis leads to helpful insights based on the progression of the input impedance during the optimization process, and to develop useful guidelines for avoiding over-design of the PDN

Episodic angioedema with hypereosinophilia (Gleich’s syndrome): A case report and extensive review of the literature

Episodic angioedema with eosinophilia (EAE) (Gleich’s syndrome) is a rare disease charac-terized by hypereosinophilia (up to 95 × 109 cells/L), recurrent episodes of angioedema, urticaria, weight gain, and fever, that occur at periodical intervals (usually every 3–4 weeks). The exact etiology of EAE is still unclear, but both eosinophils and abnormalities of cytokines homeostasis seem to play a pivotal role in the pathogenesis of the disease. In particular, the cyclic elevation of serum interleukin-5 before the increase in eosinophil count has been reported. Herein, we performed a broad literature review and report the case of a thirty-two-year-old woman with a two-year history of cyclic angioedema attacks, urticaria, periodic weight gain, and severe hypereosinophilia, diagnosed with EAE and treated with oral corticosteroids. Describing the most relevant clinical features of EAE reported so far in the literature, we aim to provide physicians with some useful tools to help them deal with this disease. In addition, we aim to raise awareness about this rare condition in which approved diagnostic classification criteria are currently missing

Fungal peritonitis in patients on peritoneal dialysis: Twenty five years of experience in a teaching hospital in Argentina

ABSTRACT Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeastrelated peritonitis could continue on the program. Key words: peritoneal dialysis, fungal peritonitis, peritonitis rates, causative microorganisms, Candida albicans, Candida spp. RESUMEN Peritonitis fúngica en pacientes en diálisis peritoneal: la experiencia de 25 años en un hospital universitario de la Argentina. La peritonitis fúngica es una complicación infrecuente pero grave de la diálisis peritoneal. Los objetivos de este trabajo fueron el análisis de las tasas de peritonitis, factores asociados, aspectos clínicos y microbiológicos, esquemas terapéuticos y evolución de los pacientes afectados. Se detectaron y documentaron microbiológicamente 183 episodios de peritonitis en 57 pacientes. Se identificaron hongos en ocho episodios (4,37%) en siete pacientes, todos ellos de sexo femenino. La tasa de peritonitis fúngica fue 0,06 episodios/paciente-año. Las coloraciones de Gram y Giemsa revelaron la presencia de microorganismos en cinco de los ocho líquidos de diálisis evaluados. Los microorganismos causales fueron Candida albicans en cinco episodios y Candida parapsilosis, Candida glabrata y Neosartorya hiratsukae en los otros tres. Todos estos pacientes, excepto uno, habían recibido antibióticos en los tres meses previos al episodio de peritonitis fúngica. El catéter de Tenckhoff fue extraído en siete de los ocho episodios. Todos los pacientes evolucionaron favorablemente. Concluimos que en la población estudiada el sexo femenino y la administración reciente de antibióticos estuvieron estrechamente relacionados con el desarrollo de peritonitis fúngicas por levaduras. Sin embargo, la peritonitis causada por el hongo filamentoso ambiental no requirió de la presión antibiótica. La microscopía del sedimento del líquido de diálisis fue útil en el manejo precoz del episodio. La peritonitis fúngica precedida por múltiples episodios de peritonitis bacteriana determinó siempre la exclusión definitiva del paciente del programa de diálisis peritoneal. Los pacientes con peritonitis de novo por levaduras, en cambio, pudieron continuar en él

The future of aortic surgery in Europe†

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS

Antiapoptotic Seminal Vesicle Protein IV Induces Histamine Release from Human FcεRI+ Cells.

BACKGROUND: Seminal vesicle protein number 4 (SV-IV) is a small, basic, multifunctional, intrinsically disordered secretory protein synthesized in large amounts by rat seminal vesicle epithelium under androgen transcriptional control. SV-IV-immunorelated proteins occur in other rat tissues and in humans. METHODS: The in vitro effect of SV-IV on human FcepsilonRI+ cells was investigated by standard immunologic, biochemical and molecular biology procedures. RESULTS: SV-IV-induced histamine release from human basophils and lung mast cells without any influence on leukotriene C(4) release and cell migration. The histamine release rate was slower compared with that induced by anti-IgE, the temperature dependence of the event being similar. SV-IV-induced histamine release was Ca2+-dependent, suggesting a physiological interaction of the protein with FcepsilonRI+ cells. SV-IV and anti-IgE acted synergistically on the histamine release. SV-IV did not induce de novo synthesis of cytokines and growth factors (transforming growth factor-beta(1), interleukin-10, interleukin-13, tumor necrosis factor-alpha, vascular endothelial growth factor A) in FcεRI+ cells. CONCLUSIONS: SV-IV protein induces in human FcεRI+ cells the release of histamine, a proinflammatory, antiapoptotic and immunosuppressive biogenic amine. These data: (1) are consistent with the antiapoptotic and immunosuppressive properties of SV-IV; (2) confirm a regulatory feature of SV-IV on mammal inflammatory reactivity by either inhibiting the arachidonate cascade pathway or stimulating proinflammatory cytokine release from lymphocyte/monocytes and histamine from FcεRI+ cells; (3) raise the possibility of a protective role of SV-IV on implanting hemiallogenic blastocysts against maternal reactive oxygen species and immunological attacks at the uterine implantation site