Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation

A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation, resuscitation, and transfer to the nearby hospital were done: echocardiography showed profound biventricular dysfunction; cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs, the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device (LVAD). Twenty-four hours later, cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up

Left ventricular assist device implantation in high risk destination therapy patients: an alternative surgical approach

Left Ventricular Assist Device (LVAD) for Destination Therapy (DT) is an established therapy for end stage heart failure patients who are not transplant candidates. Many DT patients requiring LVADs have had prior open heart surgery, the majority of whom had prior sternotomy. In addition, DT patients tend to be older and more likely to have more significant co-morbidities than their Bridge-To-Transplant (BTT) counterparts. As such, placement of an implantable LVAD in DT patients can be technically hazardous and potentially prone to more perioperative complications. The purpose of this report is to describe an alternative implantation approach for the implantation of the Heartmate II™ LVAD in high risk DT patients

Hybrid ventricular assist device: Heartmate XVE LVAD and Abiomed AB5000 RVAD.

The need for a right ventricular assist device following an implantable left ventricular assist device creates a complex situation for the surgeon, nursing staff, and the patient. The purpose of this report is to describe the rationale, technical, and perioperative issues of a hybrid ventricular assist device consisting of a Heartmate XVE (Thoratec, Inc., Pleasonton, CA) left ventricular assist device and Abiomed AB5000 right ventricular assist device (Abiomed, Inc., Danvers, MA)

Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| < 0.8) in the transverse momentum range 1 < pt < 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)

Simple Summary Little is known about factors contributing to early post-operative morbidity and mortality in low and middle income countries with a paucity of data limiting global efforts to improve gynaecological cancer care. In this multicentre, international prospective cohort study of women undergoing gynaecological oncology surgery, we show that low and middle versus high income countries were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.Abstract Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p <= 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention

Centrality, rapidity and transverse momentum dependence of J/ψJ/\psi suppression in Pb-Pb collisions at sNN\sqrt{s_{\rm NN}}=2.76 TeV

The inclusive J/$\psi$ nuclear modification factor ($R_{AA}$) in Pb-Pb collisions at $\sqrt{s_{NN}}$=2.76TeV has been measured by ALICE as a function of centrality in the $e^+e^-$ decay channel at mid-rapidity |y| < 0.8 and as a function of centrality, transverse momentum and rapidity in the $\mu^+\mu^-$ decay channel at forward-rapidity 2.5 < y < 4.The J/$\psi$ yields measured in Pb-Pb are suppressed compared to those in pp collisions scaled by the number of binary collisions.The $R_{AA}$ integrated over a centrality range corresponding to 90% of the inelastic Pb-Pb cross section is 0.72 +- 0.06 (stat.) +- 0.10 (syst.) at mid-rapidity and 0.57 +- 0.01 (stat.) +- 0.09 (syst.) at forward-rapidity. At low transverse momentum, significantly larger values of $R_{AA}$ are measured at forward-rapidity compared to measurements at lower energy.These features suggest that a contribution to the J/$\psi$ yield originates from charm quarks (re)combination in the deconfined partonic medium.The inclusive J/ψ nuclear modification factor ( RAA ) in Pb–Pb collisions at sNN=2.76 TeV has been measured by ALICE as a function of centrality in the e+e− decay channel at mid-rapidity ( |y|<0.8 ) and as a function of centrality, transverse momentum and rapidity in the μ+μ− decay channel at forward-rapidity ( 2.5<y<4 ). The J/ψ yields measured in Pb–Pb are suppressed compared to those in pp collisions scaled by the number of binary collisions. The RAA integrated over a centrality range corresponding to 90% of the inelastic Pb–Pb cross section is 0.72±0.06(stat.)±0.10(syst.) at mid-rapidity and 0.58±0.01(stat.)±0.09(syst.) at forward-rapidity. At low transverse momentum, significantly larger values of RAA are measured at forward-rapidity compared to measurements at lower energy. These features suggest that a contribution to the J/ψ yield originates from charm quark (re)combination in the deconfined partonic medium.The inclusive $J/\psi$ nuclear modification factor $R_{\rm AA}$ in Pb-Pb collisions at $\sqrt{s_{\rm NN}}$=2.76 TeV has been measured by ALICE as a function of centrality in the e$^+$e$^-$ decay channel at mid-rapidity $|y|<0.8$ and as a function of centrality, transverse momentum and rapidity in the $\mu^{+}\mu^{-}$ decay channel at forward-rapidity $2.5<y<4$.The $J/\psi$ yields measured in Pb-Pb are suppressed compared to those in pp collisions scaled by the number of binary collisions. The $R_{\rm AA}$ integrated over a centrality range corresponding to 90% of the inelastic Pb-Pb cross section is $0.72\pm0.06$ (stat.) $\pm0.10$ (syst.) at mid-rapidity and $0.57 \pm 0.01$ (stat.) $\pm0.09$ (syst.) at forward-rapidity. At low transverse momentum, significantly larger values of $R_{\rm AA}$ are measured at forward-rapidity compared to measurements at lower energy. These features suggest that a contribution to the $J/\psi$ yield originates from charm quarks (re)combination in the deconfined partonic medium