A quantitative and qualitative comparison of fibrin glue, albumin, and blood as agents to pretreat porous vascular grafts

Recent reports suggest that fibrin glue can be used to seal porous vascular grafts prior to insertion, but this ability has not been quantitatively compared to existing methods. We compared blood loss from and handling characteristics of grafts pretreated with either fibrin glue (FG) (Tisseel), albumin autoclaving (AA), or blood preclotting (BP). Five 6-cm segments of 6-mm internal diameter grafts, both knitted and woven double velour Dacron were treated in each group (30 specimens). Human blood was forced through the BP group until clotted; AA segments were soaked in 25% human albumin and autoclaved for 10 min; FG segments were treated with a topical application of Tisseel (0.5 ml/graft) followed by treatment with topical thrombin + CACl (0.5 ml/graft). Graft ends were sealed and attached to a transducer/syringe pump mechanism which pumped heparinized human blood into the graft at 100 mm Hg intraluminal pressure. All blood that leaked through the grafts over 2 min was collected and the amount was averaged for the five grafts in each group. Graft handling was characterized as either pliable or stiff. Blood pretreatment caused 21 +/- 2 and 13 +/- 4 cc/2 min of leak in knitted and woven grafts, respectively. Albumin autoclaving resulted in 9 +/- 2 and 1 +/- 0.5 cc of leak (P P < 0.01 compared to blood). Both blood and fibrin glue produced soft pliable grafts, while albumin pretreatment resulted in stiff grafts. We conclude that fibrin glue or albumin is superior to blood for pretreatment of woven grafts in limiting blood loss, but that fibrin glue is superior to either albumin or blood in knitted grafts. Fibrin glue imparts superior handling characteristics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26651/1/0000195.pd

Training future generations to deliver evidence-based conservation and ecosystem management

1. To be effective, the next generation of conservation practitioners and managers need to be critical thinkers with a deep understanding of how to make evidence-based decisions and of the value of evidence synthesis. 2. If, as educators, we do not make these priorities a core part of what we teach, we are failing to prepare our students to make an effective contribution to conservation practice. 3. To help overcome this problem we have created open access online teaching materials in multiple languages that are stored in Applied Ecology Resources. So far, 117 educators from 23 countries have acknowledged the importance of this and are already teaching or about to teach skills in appraising or using evidence in conservation decision-making. This includes 145 undergraduate, postgraduate or professional development courses. 4. We call for wider teaching of the tools and skills that facilitate evidence-based conservation and also suggest that providing online teaching materials in multiple languages could be beneficial for improving global understanding of other subject areas.Peer reviewe

A simple procedure for directly obtaining haplotype sequences of diploid genomes

Background Almost all genome sequencing projects neglect the fact that diploid organisms contain two genome copies and consequently what is published is a composite of the two. This means that the relationship between alternate alleles at two or more linked loci is lost. We have developed a simplified method of directly obtaining the haploid sequences of each genome copy from an individual organism. Results The diploid sequences of three groups of cattle samples were obtained using a simple sample preparation procedure requiring only a microscope and a haemocytometer. Samples were: 1) lymphocytes from a single Angus steer; 2) sperm cells from an Angus bull; 3) lymphocytes from East African Zebu (EAZ) cattle collected and processed in a field laboratory in Eastern Kenya. Haploid sequence from a fosmid library prepared from lymphocytes of an EAZ cow was used for comparison. Cells were serially diluted to a concentration of one cell per microlitre by counting with a haemocytometer at each dilution. One microlitre samples, each potentially containing a single cell, were lysed and divided into six aliquots (except for the sperm samples which were not divided into aliquots). Each aliquot was amplified with phi29 polymerase and sequenced. Contigs were obtained by mapping to the bovine UMD3.1 reference genome assembly and scaffolds were assembled by joining adjacent contigs that were within a threshold distance of each other. Scaffolds that appeared to contain artefacts of CNV or repeats were filtered out leaving scaffolds with an N50 length of 27–133 kb and a 88–98 % genome coverage. SNP haplotypes were assembled with the Single Individual Haplotyper program to generate an N50 size of 97–201 kb but only ~27–68 % genome coverage. This method can be used in any laboratory with no special equipment at only slightly higher costs than conventional diploid genome sequencing. A substantial body of software for analysis and workflow management was written and is available as supplementary data. Conclusions We have developed a set of laboratory protocols and software tools that will enable any laboratory to obtain haplotype sequences at only modestly greater cost than traditional mixed diploid sequences

Outcome of aortic valve repair in children with congenital aortic valve insufficiency

AbstractObjectiveSurgical aortic valvotomy has a long history of providing excellent palliation for aortic stenosis in infancy and childhood. The fate of aortic valve repairs for dominant aortic regurgitation in this same age group is considerably less clear.MethodsFrom 1990 to 2000, a total of 21 patients underwent aortic valve repair for aortic regurgitation at our institution. Seventeen patients were younger than 17 years at the time of repair (3-17 years, mean 8.1 ± 3.7 years). Of these 17 children, 6 (35%) had bicuspid valves and 11 (65%) had tricuspid valves. Type of repair varied with valve type, but repair generally consisted of commissure resuspension, partial commissure closure, triangular resection of redundant leaflets, or some combination.ResultsThere were no deaths. Follow-up ranged from 1 to 11 years (mean 5.3 ± 2.4 years). At present 3 of 17 (17.6%) have mild aortic regurgitation according to echocardiography and 6 (35.2%) have moderate aortic regurgitation. In 8 of 17 cases (47.1%) the repair clearly failed, requiring reoperation from 0.5 to 73 months after the original operation (mean 18.9 months). Reoperation consisted of 6 Ross procedures and 2 mechanical aortic valve replacements. There were no deaths at the secondary operation.ConclusionAortic valve repair in children with a dominant feature of aortic insufficiency tended to fail progressively and at a high rate. Leaflet thickening was associated with higher risk of repair failure in this series. The threshold for aortic valve replacement should remain low

Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass

AbstractBackground: There has been resurgent interest in coronary revascularization performed on the beating heart. Heretofore, there has been no long-term comparison of this technique to traditional coronary artery bypass with cardioplegia. Objective: The purpose of this study was to provide a comparison of long-term survival and intervention-free outcome between patient groups subjected to coronary bypass accomplished with or without the use of cardiopulmonary bypass. Method: From June 1989 to July 1990, all patients treated for coronary revascularization by three surgeons were considered for coronary revascularization with the heart beating: 107 patients underwent coronary bypass on the beating heart, and 112 patients underwent revascularization with the aid of bypass with cardioplegia. Mean ages (65 ± 10 years) and risk factors were identical. Patients operated on with the heart beating had 2.4 ± 0.9 grafts versus 3.2 ± 1.1 grafts for patients having cardiopulmonary bypass with cardioplegia. Results: At 7-year follow-up, 86 of 107 (80%) patients operated on with the heart beating were alive versus 88 of 112 (79%) patients in whom cardiopulmonary bypass with cardioplegia was used. Cardiac deaths occurred in 13 of 107 (12%) patients in the former group versus 10 of 112 (9%) patients in the latter group. However, 32 of 107 patients operated on with the heart beating (30%) needed catheterization for their symptoms versus 18 of 112 (16%) patients in the bypass with cardioplegia group (p = 0.01). This results in 21 of 107 (20%) patients in the beating heart group needing angioplasty or a second coronary bypass versus only 8 of 112 (7%) patients in the bypass with cardioplegia group. No patient in the bypass with cardioplegia group required reoperation. Most of the reinterventions for the beating heart group were percutaneous transluminal coronary angioplasty (15 of 21 [71%] patients). Conclusion: Despite one less graft per patient, survival and cardiac death rates were similar for the two groups. However, twice as many patients in the beating heart group required recatheterization (30% versus 16%), and 20% needed a second intervention. Only 7% of the bypass with cardioplegia group required reintervention. Limited revascularization of the beating heart provides long-term results comparable to full revascularization with cardiopulmonary bypass, but at the cost of a threefold increase in reinterventions. (J Thorac Cardiovasc Surg 1998;115:1273-8