Huge Interatrial Septal Aneurysm: A Coincidental but Rather Fatal Finding

We report the case of a patient with a huge interatrial septal aneurysm as an intraoperative coincidental finding that led to a fatal outcome. The patient was admitted to our hospital in order to undergo elective coronary artery bypass grafting because he suffered from severe coronary artery disease. We intraoperatively diagnosed by transesophageal echocardiography a huge interatrial septal aneurysm mimicking a right atrial tumor. The aneurysm was initially resected and then coronary artery bypass grafting was successfully performed but the patient never achieved a successful separation from cardiopulmonary bypass probably because of massive embolic events

Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria for the diagnosis of infective endocarditis in a multicenter cohort of patients with Staphylococcus aureus bacteremia

BACKGROUND The Duke criteria for infective endocarditis (IE) diagnosis underwent revisions in 2023 by the European Society of Cardiology (ESC) and the International Society for Cardiovascular Infectious Diseases (ISCVID). This study aims to assess the diagnostic accuracy of these criteria, focusing on patients with Staphylococcus aureus bacteremia (SAB). METHODS This Swiss multicenter study conducted between 2014 and 2023 pooled data from three cohorts. It evaluated the performance of each iteration of the Duke criteria by assessing the degree of concordance between definite S. aureus IE (SAIE) and the diagnoses made by the Endocarditis Team (2018-23) or IE expert clinicians (2014-17). RESULTS Among 1344 SAB episodes analyzed, 486 (36%) were identified as cases of SAIE. The 2023 Duke-ISCVID and 2023 Duke-ESC criteria demonstrated improved sensitivity for SAIE diagnosis (81% and 82%, respectively) compared to the 2015 Duke-ESC criteria (75%). However, the new criteria exhibited reduced specificity for SAIE (96% for both) compared to the 2015 criteria (99%). Spondylodiscitis was more prevalent among patients with SAIE compared to those with SAB alone (10% versus 7%, P 0.026). However, when patients meeting the minor 2015 Duke-ESC vascular criterion were excluded, the incidence of spondylodiscitis was similar between SAIE and SAB patients (6% versus 5%, P 0.461). CONCLUSIONS The 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria, show improved sensitivity for SAIE diagnosis compared to 2015 Duke-ESC criteria. However, this increase in sensitivity comes at the expense of reduced specificity. Future research should aim at evaluating the impact of each component introduced within these criteria

Evaluation of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Criteria in a Multicenter Cohort of Patients With Suspected Infective Endocarditis

Background Since publication of Duke criteria for infective endocarditis (IE) diagnosis, several modifications have been proposed. We aimed to evaluate the diagnostic performance of the Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) 2023 criteria compared to prior versions from 2000 (Duke-Li 2000) and 2015 (Duke-ESC [European Society for Cardiology] 2015). Methods This study was conducted at 2 university hospitals between 2014 and 2022 among patients with suspected IE. A case was classified as IE (final IE diagnosis) by the Endocarditis Team. Sensitivity for each version of the Duke criteria was calculated among patients with confirmed IE based on pathological, surgical, and microbiological data. Specificity for each version of the Duke criteria was calculated among patients with suspected IE for whom IE diagnosis was ruled out. Results In total, 2132 episodes with suspected IE were included, of which 1101 (52%) had final IE diagnosis. Definite IE by pathologic criteria was found in 285 (13%), 285 (13%), and 345 (16%) patients using the Duke-Li 2000, Duke-ESC 2015, or the Duke-ISCVID 2023 criteria, respectively. IE was excluded by histopathology in 25 (1%) patients. The Duke-ISCVID 2023 clinical criteria showed a higher sensitivity (84%) compared to previous versions (70%). However, specificity of the new clinical criteria was lower (60%) compared to previous versions (74%). Conclusions The Duke-ISCVID 2023 criteria led to an increase in sensitivity compared to previous versions. Further studies are needed to evaluate items that could increase sensitivity by reducing the number of IE patients misclassified as possible, but without having detrimental effect on specificity of Duke criteria

Transcatheter heart valve commissural alignment: an updated review

Transcatheter aortic valve replacement (TAVR) indications recently extended to lower surgical risk patients with longer life expectancy. Commissural alignment (CA) is one of the emerging concepts and is becoming one of the cornerstones of the TAVR procedure in a patient with increased longevity. Indeed, CA may improve transcatheter heart valve (THV) hemodynamics, future coronary access, and repeatability. The definition of CA has been recently standardized by the ALIGN-TAVR consortium using a four-tier scale based on CT analysis. Progress has been made during the index TAVR procedure to optimize CA, especially with self-expandable platforms. Indeed, specific delivery catheter orientation, THV rotation, and computed-tomography-derived views have been proposed to achieve a reasonable degree of CA. Recent data demonstrate feasibility, safety, and a significant reduction in coronary overlap using these techniques, especially with self-expandable platforms. This review provides an overview of THV CA including assessment methods, alignment techniques during the index TAVR procedure with different THV platforms, the clinical impact of commissural misalignment, and challenging situations for CA

Intravenous levosimendan-norepinephrine combination during off-pump coronary artery bypass grafting in a hemodialysis patient with severe myocardial dysfunction

This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 μg/kg/min and 0.05 μg/kg/min respectively) started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ethical reasoning in Aristotle’s rhetoric: a didactic approach to education and mediation

This dissertation aims at indicating that the complex cognitive process concerning human beings in Aristotle’s philosophy requires the instrumental force of the alluring reasoning, emerging from the Art of Rhetoric. This kind of reasoning contributes to the existence of realistic optimism and – based on Aristotle’s ethics – has been throughout the ages an unintentional or intentional choice of human communities. It is also being emphasized that rhetoric without ethical principles-virtues does not undergo restrictions, judgments or analyses, while the ethical principles-virtues can be solely activated through the instrumental force of the Art of Rhetoric. This study comprises three main parts, whose structure totally adheres to the primary topic of the study, aiming at maintaining text coherence. The first part refers to the attitude of the Athenians towards the systematic rhetoric, introduced in the cradle of wisdom, namely Athens. Within this framework, the consequences of the art of Gorgias are being defined, preparing the ground for Plato’s strict judgment. Furthermore, some certain factors are being classified, which led to the essential transformation of philosophy into an ideal science for the majority of the citizens. On the second part, the causal relationship between ethics and Aristotle’s rhetoric is being explained, since ethics constitute the main component of the three branches of Rhetoric, namely deliberative, judicial and epideictic. Aristotle’s rhetoric is being assessed in an evaluative, cognitive and practical manner, while his main purpose is being fulfilled: the bidirectional association between the art of persuasion and ethical reasoning .The cultivation of every citizen since childhood, based on philosophy education related to ethics, proves that ethics and rhetoric are being correlated, while people’s weaknesses (pathos) in Aristotle’s work turn remarkably into tools for facilitating the establishment of ethical reasoning within humanity. On the third part of this study the significance and timelessness of Aristotle’s philosophy is being pointed out as well as the importance of his contribution to Education Sciences and contemporary ways of communication within a society. Moreover, corrective justice, having been introduced by Aristotle along with the Art of Rhetoric, are considered the most substantial components of contemporary mediation. The final chapter of this study includes the main conclusion: ethics introduce reasoning in the Art of Rhetoric and therefore Aristotle – and his work in general – is being acknowledged as the first cognitive science theoretician, a scientific field that regards sense, cognition, reasoning, memory, knowledge and skills obtainment, that is to say cognitive development. Moreover, Aristotle is rightly considered as the mentor of the 'out-of-court dispute resolution', i.e. mediation, since he selects corrective justice and leniency within human communities. Lastly, it is notable that still nowadays Aristotle remains justly one of the most eminent and interesting personalities universally.Σκοπός της παρούσας διατριβής είναι να καταδειχθεί πως στη φιλοσοφία του Αριστοτέλη η περίπλοκη γνωσιακή διαδικασία που χαρακτηρίζει τον άνθρωπο απαιτεί την εργαλειακή ισχύ του ελκτικού λόγου, όπως αυτός αναδύεται στην Τέχνη Ῥητορική. Πρόκειται για έναν ρητορικό λόγο που επιτυγχάνει μια ρεαλιστική αισιοδοξία, καθώς, ερειδόμενος στα στέρεα θεμέλια της αριστοτελικής ηθικής, αποτελεί διαχρονικά την εκούσια ή ακούσια επιλογή της κοινότητας των ανθρώπων. Με ζήλο υποστηρίζεται πως ο ρητορικός λόγος δίχως ηθικές αρχές – αρετές δεν υπόκειται σε περιορισμούς, κρίσεις ή αναλύσεις, ενώ οι ηθικές αρχές – αρετές χωρίς την εργαλειακή δύναμη της τέχνης του λόγου είναι ανενεργές. Συγκεκριμένα η μελέτη διακρίνεται σε τρία βασικά μέρη. Η δομή της ακολουθεί πιστά τη θεματολογία της με στόχο την έλλογη συνοχή. Στο πρώτο μέρος ανιχνεύεται η υποδοχή από το αθηναϊκό κοινό της συστηματικής ρητορικής στην Αθήνα, παρατηρούνται τα επίχειρα της τέχνης του Γοργία και προοικονομείται με αυτόν τον τρόπο η πλατωνική κριτική. Συνάμα ο αναγνώστης δύναται να διαχωρίσει τους παράγοντες που κατέστησαν αναγκαία τη μετουσίωση της φιλοσοφίας σε ιδανική επιστήμη και αναδεικνύεται η αναγκαιότητα αναπλαισίωσης της ρητορικής. Στο δεύτερο μέρος εξηγείται η αιτιώδης σχέση ηθικής και αριστοτελικής ρητορικής, αφού η ηθική αποδεικνύεται βασική συνιστώσα στα τρία είδη του ρητορικού λόγου, του συμβουλευτικού, του επιδεικτικού και του δικανικού. Η αριστοτελική ρητορική κρίνεται αξιολογικά, γνωσιολογικά και πρακτικά, ενώ πραγματώνεται ο στόχος του Σταγειρίτη για την αμφίδρομη σχέση της τέχνης της πειθούς με τον ηθικό λόγο. Η καλλιέργεια του πολίτη από τη νεαρή ηλικία με την ηθοπλαστικού περιεχομένου φιλοσοφική παιδεία αποτελεί εγγύηση και ταυτόχρονα διαπίστευση του δεσμού της ηθικής με τη ρητορική, ενώ τα ανθρώπινα πάθη παραδόξως στο έργο του Αριστοτέλη μεταβάλλονται σε εργαλεία για τη θεμελίωση του ηθικού λόγου στην ανθρώπινη κοινότητα. Στο τρίτο μέρος επιβεβαιώνεται η σπουδαιότητα και η διαχρονικότητα του Αριστοτέλη, γιατί είναι σημαντική η συμβολή του στις επιστήμες της αγωγής και στις σύγχρονες μορφές επικοινωνίας· επιπλέον το αριστοτελικό επανορθωτικό δίκαιο, όπως και η Τέχνη Ῥητορική στο σύνολό της, καθίστανται τα ουσιωδέστερα συστατικά του σύγχρονου θεσμού της διαμεσολάβησης. Στον επίλογο διατυπώνεται το καταληκτικό συμπέρασμα πως η ηθική συστήνει τον λόγο στην Τέχνη Ῥητορική και καθίσταται ο Αριστοτέλης ο πρώτος θεωρητικός της γνωσιακής επιστήμης, ερευνητικό πεδίο της οποίας είναι η αντίληψη, η νόηση, ο λόγος, το μνημονικό, η απόκτηση γνώσεων και δεξιοτήτων, ολιστικά η γνωσιακή ανάπτυξη. Επιπρόσθετα δίκαια θεωρείται μέντορας του εξωδικαστικού τρόπου επίλυσης διαφορών, της διαμεσολάβησης, αφού προκρίνει το διορθωτικό δίκαιο και το ἐπιεικές στην κοινότητα των ανθρώπων. Έλλογα λοιπόν ο Αριστοτέλης παραμένει στη σύγχρονη εποχή μια από τις πιο σημαντικές και ενδιαφέρουσες προσωπικότητες σε παγκόσμια κλίμακα

Dynamic and turbulent change: food retail developments in Greece.

Analyzes the revolutionary changes in Greek retailing industry from 1991 to 2003. Merger and acquisition activity; Information on the format development that has emerged; Proportion of food stores operated by multiple retailers in 2001; Assessment of potential effects of legislative changes