Mathematics, capitalism and biosocial research

In my previous work, I criticised studies within the sociopolitical turn for disavowing a comprehension of schools as places of capitalist production. Here, I extend this critique to what is being flagged as a new turn in educational research. I am referring to biosocial research, particularly in the way it is coupled with new materialist and more than human philosophies in the work of Elizabeth de Freitas. I use elements from Marxian theory and Lacanian psychoanalysis to explore the concomitances between mathematics and capitalism, showing how both mathematics and capital need to suture the subject in order to thrive. Biosocial research epitomises this drive towards automation and totality, and, notwithstanding de Freitas’ attempts to rescue it from the logic of control, I will argue that agent-centred intentions dismiss the underlying workings of capital as a real abstraction. I do so by engaging with elements of Deleuze’s philosophy, showing how the more than human frame in which de Freitas’ biosocial research rests contradicts her own perception of how biosocial research can be rescued for inclusive purposes

Volatile anesthetics for periprocedural cardiac protection: A review

All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may, therefore, have a beneficial role on the myocardial oxygen balance during ischemia. Recently, experimental evidence has clearly demonstrated that in addition to these indirect protective effects, volatile anesthetic agents also have direct protective properties against ischemic myocardial damage. The implementation of these properties during clinical anesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and incidence of myocardial infarction following cardiac surgery with significant advantages in terms of postoperative cardiac troponin release, need for inotrope support, time on mechanical ventilation, intensive care unit and overall hospital stay. Multicenter, randomized clinical trials had previously demonstrated that the use of desflurane can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization, following coronary artery bypass graft surgery, either with and without cardiopulmonary bypass. Evidence in non-coronary surgical settings is contradictory and will be reviewed in this paper together with the mechanism of cardiac protection by volatile agents

Cardiac protection by volatile anesthetics. A review

All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may thus improve the myocardial oxygen balance during ischemia. Recent experimental evidence has clearly demonstrated that, in addition to these indirect effects, volatile anesthetic agents also directly protect from ischemic myocardial damage. Implementation of these effects during clinical anesthesia can provide an additional tool for treatment or prevention of ischemic cardiac dysfunction during the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and the incidence of myocardial infarction following cardiac surgery, with significant advantages in terms of postoperative cardiac troponin release, need for inotropic support, and time on mechanical ventilation, as well as in time spent in the intensive care unit and overall hospital stay. Multicenter, randomized clinical trials previously demonstrated that desflurane could reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft surgery, either with or without cardiopulmonary bypass. However, evidence in non-coronary surgical settings is contradictory and will be reviewed in this paper, together with the mechanism of cardiac protection by volatile agents

Volatile anesthetics reduce mortality in cardiac surgery.

Objectives: A recent meta-analysis suggested that volatile anesthetics reduce postoperative mortality after cardiac surgery. Nonetheless, whether volatile anesthetics improve the outcome of cardiac surgical patients is still a matter of debate. The authors investigated whether the use of volatile anesthetics reduces mortality in cardiac surgery. Design, Setting, and Interventions: A longitudinal study of 34,310 coronary artery bypass graft interventions performed in Italy estimated the risk-adjusted mortality ratio for each center. A survey was conducted among these centers to investigate whether the use of volatile anesthetics showed a correlation with mortality. Measurements and Main Results: All 64 eligible centers provided the required data. The median unadjusted 30-day mortality among participating centers was 2.2% (0.3-8.8), whereas the median risk-adjusted 30-day mortality was 1.8% (0.1-7.2). Risk-adjusted analysis showed that the use of volatile anesthetics was associated with a significantly lower rate of risk-adjusted 30-day mortality (beta = -1.172 [-2.259, -0.085], R(2) = 0.070, p = 0.035). Dichotomization into centers using volatile anesthetics in at least 25% of their cases or in less than 25% yielded even more statistically significant results (p = 0.003). Furthermore, a longer use of volatile anesthetics was associated with a significantly lower death rate (p = 0.022); and exploring the impact of the specific volatile anesthetic agent, the use of isoflurane was associated with significant reductions in risk-adjusted mortality rates (p = 0.039). Conclusions: This survey among 64 Italian centers shows that risk-adjusted mortality may be reduced by the use of volatile agents in patients undergoing coronary artery bypass graft surgery. (C) 2009 Elsevier Inc. All rights reserve

Impact of impedance threshold devices on cardiopulmonary resuscitation: A systematic review and meta-analysis of randomized controlled studies

Objectives: Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially beneficial decrease in intrathoracic pressure and thus increasing venous return to the heart. This review provides an update on the impedance threshold device and underlines its effect on shortterm survival. Data Source: MedCentral, CENTRAL, PubMed, and conference proceedings were searched (updated March 27, 2007). Authors and external experts were contacted. Study Selections: Three unblinded reviewers selected randomized trials using an impedance threshold device in cardiopulmonary resuscitation of nontraumatic out-of-hospital cardiac arrests. Four reviewers independently abstracted patient, treatment and outcome data. Data Extraction: A total of 833 patients from five high quality randomized studies were included in the analysis. Data Synthesis: Pooled estimates showed that the impedance threshold device consistently and significantly improved return to spontaneous circulation (202/438 [46%] for impedance threshold device group vs. 159/445 [36%] for control, relative risk [RR] 1.29 [1.10 \u20131.51], p .002), early survival (139/428 [32%] vs. 97/433 [22%], RR 1.45 [1.16 \u20131.80], p .0009) and favorable neurologic outcome (39/307 [13%] vs. 18/293 [6%], RR 2.35 [1.30\u20134.24], p .004) with no effect on favorable neurologic outcome in survivors (39/60 [65%] vs. 18/44 [41%]) nor an improved survival at the longest available follow up (35/428 [8.2%] vs. 24/433 [5.5%]). Conclusions: This meta-analysis of randomized controlled studies suggests that the impedance threshold device improves early outcome in patients with out-of-hospital cardiac arrest undergoing cardiopulmonary resuscitation

A propensity score analysis on the effect of eliminating cardiopulmonary bypass for coronary artery bypass grafting

Aim. The aim of the study was to investigate if the off-pump technique could reduce the hospital mortality after coronary artery bypass grafting when compared to the standard cardiopulmonary bypass (CPB) technique. Methods. An observational study with propensity score matching analysis was performed in a university teaching hospital in 2 899 consecutive patients undergoing elective coronary artery bypass grafting. No intervention was performed. Major perioperative complications and hospital mortality were noted. Results. The overall hospital mortality was 1.3% (39/2 899) with no difference between the off-pump (16/802, 2.0%) and the CPB group (23/2 097, 1.1%) P=0.09. Since the off-pump group included patients at high risk, a propensity score analysis was then performed and off-pump patients matched 1:1 to CPB patients in order to have the same pre-operative variables identified by a multivariate analysis as associated to surgeon propensity to operate off-pump: (age, chronic renal failure and low ejection fraction) and the same number of graft performed. The results of the propensity matching still showed no difference in hospital mortality between off-pump and CPB group (1.6% vs 1.1% P=0.6). The off-pump technique showed advantages in terms of transfusion of blood products (P<0.001) and reduction of surgical re-exploration (P=0.04). Conclusion. No difference in hospital mortality in coronary artery bypass grafting patients could be observed between patients operated off-pump or with the standard CPB technique

Regulation of catalase expression in chronic lymphocytic leukemia cells.

The aim of this study is to investigate the genetic, transcriptional and post-transcriptional processes that underlie the catalase expression in CLL subtypes

Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery:a meta-analysis

Objective: Acute renal failure is a common and threatening complication in patients undergoing cardiovascular surgery. To determine the efficacy of fenoldopam in the prevention of acute renal failure, the authors performed a systematic review of randomized, controlled trials and propensity-matched studies in patients undergoing cardiovascular surgery. Design: Meta-analysis. Setting: Hospitals. Participants: A total of 1,059 patients from 13 randomized and case-matched studies were included in the analysis. Interventions: None. Measurements and Main Results: Google Scholar, PubMed, and scientific sessions were searched (updated November 2006). Authors and external experts were contacted. Four unblinded reviewers selected controlled trials that used fenoldopam in the prevention or treatment of acute renal failure in cardiovascular surgery. Four reviewers independently abstracted patient data, treatment characteristics, and outcomes. Pooled estimates showed that fenoldopam consistently and significantly reduced the need for renal replacement therapy (odds ratio = 0.37 [0.23-0.59], p < 0.001) and in-hospital death (odds ratio = 0.46 [0.29-0.75], p = 0.01). These benefits were associated with shorter intensive care unit stay (weighted mean difference [WMD] = -0.93 days [-1.27; -0.58], p = 0.002). Sensitivity analyses, tests for small study bias, and heterogeneity assessment further confirmed the main analysis. Conclusions: This meta-analysis provides evidence that fenoldopam may confer significant benefits in preventing renal replacement therapy and reducing mortality in patients undergoing cardiovascular surgery. © 2008 Elsevier Inc. All rights reserved