peri procedural thrombocytopenia after aortic bioprosthesis implant a systematic review and meta analysis comparison among conventional stentless rapid deployment and transcatheter valves

Abstract Background Thrombocytopenia has been shown to occur soon after surgical biological aortic valve replacement (AVR), and recently reported also after transcatheter valve implantation (TAVI). The mechanism underlying this phenomenon is still unknown, and its clinical impact on the peri-operative outcome has been poorly investigated. Methods A systematic review and a meta-analysis of all available studies reporting data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented (stented-AVR) valves, have been performed. Results Fifteen trials (2.163 patients) were included in the meta-analysis. Perioperative platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77% in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI (apparently, balloon-expandable valves more frequently associated to thrombocytopenia). Stented-AVR required more red blood cells transfusion than stentless-AVR (P  Conclusions Thrombocytopenia-related major adverse events were mainly reported in TAVI patients, whereas clinically meaningless in surgical patients. Transient peri-procedural thrombocytopenia is common after bio-AVR, regardless of prosthesis's type or implant modality. It should receive appropriate monitoring and focused investigations

Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses

Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population

Healthcare IT Utilization and Penetration among Physicians: Novel IT Solutions in Healthcare – Use and Acceptance in Hospitals

Background: Healthcare IT (HIT) increasingly gains public attention and clinical daily relevance. A growing number of patients and physicians increasingly relies on IT services to monitor and support well-being and recovery both in their private and professional environment. This is assumed to develop rapidly in the upcoming years. Objective: This study examines the current status of HIT, its use and penetration among physicians in hospitals and researches utilization as well as future expectations regarding HIT. Methods: Physicians in Germany, Austria and Switzerland were addressed via e-mail to answer a standardized Internet-based questionnaire consisting of 17 multiple-choice and 3 open text questions. Parameters were evaluated in 5 categories: general use, frequency, acceptance, IT needs and future expectations. Results: An overall 234 physicians (response rate 83.6%) with a median age of 45 (range 25–60) responded and filled out the entire online questionnaire. A significant correlation between parameters gender, age and level of training (resident, specialist, consultant etc.) was proven. The professional, medical employment of technology shows a strong correlation with age as well as level of training. Whereas increasing age among physicians is associated with a decreasing level of application of HIT, a higher training level is accompanied by an increasing level of professional application of IT services and tools within the healthcare context. Routine employment of HIT is regarded as a necessary and positive standard. Most users assume the importance of HIT to strongly grow in the future in comparison to current use. A clear lack of trust towards data security and storage is recognized on both patient and physician sides. Needs are currently satisfied by employing privately acquired IT in the professional setup rather than the hospitals’. Future expectations from HIT show a clear demand for interoperability and exchangeability of data. Conclusions: The results display a clear gap between demand and expectations of IT for medical purposes. The rate of use of HIT applications generally correlates with age, gender as well as role within the hospital and type of employment within the healthcare sector. The current offering does not satisfy the needs of healthcare professionals

Coffee Bioactive N-Methylpyridinium Attenuates Tumor Necrosis Factor (TNF)-α-Mediated Insulin Resistance and Inflammation in Human Adipocytes

Although coffee consumption has been historically associated with negative health outcomes, recent evidence suggests a lower risk of metabolic syndrome, obesity and diabetes among regular coffee drinkers. Among the plethora of minor organic compounds assessed as potential mediators of coffee health benefits, trigonelline and its pyrolysis product N-methylpyridinium (NMP) were preliminary shown to promote glucose uptake and exert anti-adipogenic properties. Against this background, we aimed at characterizing the effects of trigonelline and NMP in inflamed and dysfunctional human adipocytes. Human Simpson-Golabi-Behmel syndrome (SGBS) adipocytes were treated with NMP or, for comparison, trigonelline, for 5 h before stimulation with tumor necrosis factor (TNF)-α. NMP at concentrations as low as 1 µmol/L reduced the stimulated expression of several pro-inflammatory mediators, including C-C Motif chemokine ligand (CCL)-2, C-X-C Motif chemokine ligand (CXCL)-10, and intercellular adhesion Molecule (ICAM)-1, but left the induction of prostaglandin G/H synthase (PTGS)2, interleukin (IL)-1β, and colony stimulating factor (CSF)1 unaffected. Furthermore, NMP restored the downregulated expression of adiponectin (ADIPOQ). These effects were functionally associated with downregulation of the adhesion of monocytes to inflamed adipocytes. Under the same conditions, NMP also reversed the TNF-α-mediated suppression of insulin-stimulated Ser473 Akt phosphorylation and attenuated the induction of TNF-α-stimulated lipolysis restoring cell fat content. In an attempt to preliminarily explore the underlying mechanisms of its action, we show that NMP restores the expression of the master regulator of adipocyte differentiation peroxisome proliferator-activated receptor (PPAR)γ and downregulates activation of the pro-inflammatory mitogen-activated protein jun N-terminal kinase (JNK). In conclusion, NMP reduces adipose dysfunction in pro-inflammatory activated adipocytes. These data suggest that bioactive NMP in coffee may improve the inflammatory and dysmetabolic milieu associated with obesity

Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Surgery

International audienceObjective The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative complications in patients undergoing coronary artery bypass grafting (CABG). Design Retrospective, observational study. Setting University hospital. Participants A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG. Interventions Isolated CABG. Measurements and Main Results The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all-cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p<0.0001) and adjusted analysis (p<0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p<0.0001). The grading method (p<0.0001) and the additive score (rho, 0.514; p<0.0001) were predictive of the length of intensive care unit stay. Conclusions The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surger

Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry.

Background Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome

Assessment of Subjective Well-Being in a Cohort of University Students and Staff Members: Association with Physical Activity and Outdoor Leisure Time during the COVID-19 Pandemic

Time spent outdoors and physical activity (PA) promote mental health. To confirm this relationship in the aftermath of COVID-19 lockdowns, we explored individual levels of anxiety, depression, stress and subjective well-being (SWB) in a cohort of academic students and staff members and tested their association with sport practice, PA at leisure time and time spent outdoors. Our cross-sectional study collected data during the COVID-19 outbreak (April–May 2021) on 939 students and on 238 employees, who completed an online survey on sociodemographic and lifestyle features, depression, anxiety, stress, and SWB. Results showed that the students exhibited higher levels of anxiety, depression, and stress, and lower levels of SWB (p < 0.001 for all domains) compared to the staff members. Correlation analysis confirmed that PA and time spent in nature were associated to high mental health scores among staff and, more consistently, among students. Finally, mediation analyses indicated that the time spent in nature, social relationships, and levels of energy play a mediator role in the relationship between sport practice and SWB. Our evidence reinforces the protective role of time spent in nature in improving mental health, and provides support for policymakers to make appropriate choices for a better management of COVID-19 pandemic consequencesP.P. was funded by Life Quality Research Centre—UIDP/04748/2020, a program financially supported by FCT—Fundação para a Ciência e Tecnolo-gia/Ministério da Educação e Ciência.Peer reviewe

Numerical simulation of the filling and curing stages in reaction injection moulding, using CFX

Mestrado em Engenharia MecânicaOs métodos habitualmente utilizados para a simulação de injecção em moldes envolvem um número considerável de simplificações, originando reduções significativas do esforço computacional mas, nalguns casos também limitações. Neste trabalho são efectuadas simulações de Reaction Injection Moulding (RIM) com o mínimo de simplificações, através da utilização do software de CFD multi-objectivos CFX, concebido para a simulação numérica de escoamentos e transferência de calor e massa. Verifica-se que o modelo homogéneo para escoamentos multifásicos do CFX, geralmente considerado o apropriado para a modelação de escoamentos de superfície livre em que as fases estão completamente estratificadas, é incapaz de modelar correctamente o processo de enchimento. Este problema é ultrapassado através da implementação do modelo não homogéneo juntamente com a condição de fronteira de escorregamento livre para o ar. A reacção de cura é implementada no código como uma equação de transporte para uma variável escalar adicional, com um termo fonte. São testados vários esquemas transitórios e advectivos, com vista ao reconhecimentos de quais os que produzem os resultados mais precisos. Finalmente, as equações de conservação de massa, quantidade de movimento, cura e energia são implementadas conjuntamente para simular os processos simultâneos de enchimento e cura presentes no processo RIM. Os resultados numéricos obtidos reproduzem com boa fidelidade outros resultados numéricos e experimentais disponíveis, sendo necessários no entanto tempos de computação consideravelmente longos para efectuar as simulações. ABSTRACT: Commonly used methods for injection moulding simulation involve considerable number of simplifications, leading to a significant reduction of the computational effort but, in some cases also to limitations. In this work, Reaction Injection Moulding (RIM) simulations are performed with minimum of simplifications, by using the general purpose CFD software package CFX, designed for numerical simulation of fluid flow and heat and mass transfer. The CFX’s homogeneous multiphase flow model, which is generally considered to be the appropriate choice for modelling free surface flows where the phases are completely stratified and the interface is well defined, is shown to be unable to model the filling process correctly. This problem is overcome through the implementation of the inhomogeneous model in combination with the free-slip boundary condition for the air phase. The cure reaction is implemented in the code as a transport equation for an additional scalar variable, with a source term. Various transient and advection schemes are tested to determine which ones produce the most accurate results. Finally, the mass conservation, momentum, cure and energy equations are implemented all together to simulate the simultaneous filling and curing processes present in the RIM process. The obtained numerical results show a good global accuracy when compared with other available numerical and experimental results, though considerably long computation times are required to perform the simulations

Bleeding in Patients Treated With Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting

BackgroundWe evaluated perioperative bleeding after coronary artery bypass grafting (CABG) in patients preoperatively treated with ticagrelor or clopidogrel, stratified by discontinuation of these P2Y12 inhibitors.MethodsAll patients from the prospective, European Multicenter Registry on Coronary Artery Bypass Grafting (E-CABG) treated with ticagrelor or clopidogrel undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding, stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included four additional definitions of major bleeding. Propensity score matching was performed to adjust for differences in preoperative and perioperative covariates.ResultsOf 2,311 patients who were included, 1,293 (55.9%) received clopidogrel and 1,018 (44.1%) ticagrelor preoperatively. Mean time between discontinuation and the operation was 4.5 ± 3.2 days for clopidogrel and 4.9 ± 3.0 days for ticagrelor. In the propensity score–matched cohort, ticagrelor-treated patients had a higher incidence of major bleeding according to Universal Definition of Perioperative Bleeding when ticagrelor was discontinued 0 to 2 days compared with 3 days before the operation (16.0% vs 2.7%, p = 0.003). Clopidogrel-treated patients had a higher incidence of major bleeding according to the Universal Definition of Perioperative Bleeding when clopidogrel was discontinued 0 to 3 days compared with 4 to 5 days before the operation (15.6% vs 8.3%, p = 0.031).ConclusionsIn patients receiving ticagrelor 2 days before CABG and in those receiving clopidogrel 3 days before CABG, there was an increased rate of severe bleeding. Postponing nonemergent CABG for at least 3 days after discontinuation of ticagrelor and 4 days after clopidogrel should be considered.</div