Indications, complications, and outcomes of cardiac surgery after heart transplantation: results from the cash study

[Abstract] Background: Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods: We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion: Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure

A framework for assessing work integrated learning

The aim of our research is to provide a unified model for the composition and management of consumer care services. We identify design, composition, distribution and management as key stages of this model and propose an Intelligent Collaborative Care Management (ICCM) System as its realisation. The distribution and management stages are implemented as multi-agent systems. Agents in the distribution stage carry out domain-specific negotiation and distribution processes for the assignment of tasks in the care plan. Through the agents in the management stage, we introduce the notion of 'failure prevention' and 'adherence support' in contrast to 'failure recovery' in planning. The key to failure prevention is to identify what has to be carried out to prevent care plan failures. The healthcare domain is used to demonstrate the ICCM system

Tumoral vascular density in breast tumors and their effect on recurrence-free survival Tumorale Gefässdichte bei Mammatumoren und ihr Einfluss auf das rezidivfreie Uberleben

Angiogenesis quantitation of 106 patients with primary breast cancer and 35 patients with adenofibroma of the breast was compared and examined to its prognostic relevance for five-years disease-free survival in breast cancer patients. Immunocytochemical staining for Factor VIII-related antigen was performed to outline vascular endothelium. We found a significant higher vessel density in breast cancer patients who experienced recurrence (17.4) than in those with no recurrence (9.4) or with adenofibroma (8.7) [p < 0.0001]. The probability of five-years recurrence-free survival for patients with a primary tumor of high vessel density was at 52.3% and 86.4% for tumors of low microvessel density (p < 0.0011). Microvessel density proved to be an independent prognostic factor for breast cancer recurrence in the Cox-Model (relative risk 2.047, p = 0.0002)

Blood-Vessel Invasion in Breast-Cancer - a Comparison of Hematoxylin-Eosin Staining and Immunohistochemical Staining for Factor-Viii Antigen for Their Prognostic Value Concerning Tumor Recurrence

Blood vessel invasion was investigated with haematoxylin-eosin (HE) staining and immuno-histochemical staining for factor VIII antigen (F VIII) in 106 patients with primary carcinoma of the breast, in order to compare their value in prognosticating the probability of recurrence. Blood vessel invasion was diagnosed in 65 cases (61.9%) by HE, but in only 45 (43.4%) by F VIII staining. Lymph-node status and blood vessel invasion correlated positively on HE (r = 0.73; P = 0.0001), but not so on F VIII staining. Multivariate logistic regression showed blood vessel invasion to be a strongly independent prognostic factor for recurrence-free survival with F VIII staining (odds ratio: = 7.19; P = 0.0001), while HE staining was not independent from other prognostic factors. These preliminary data thus suggest that demonstrating vascular invasion by F VIII staining may identify those patients with a very high risk of recurrence, independent of lymph-node status

Blood vessel invasion in breast cancer. A comparison of haematoxylin-eosin staining and immunohistochemical staining for factor VIII antigen for their prognostic value concerning tumour recurrence TUMORGEFASSINVASION BEIM MAMMAKARZINOM. HAMATOXYLIN-EOSIN- VERSUS IMMUNHISTOCHEMISCHE FARBUNG GEGEN FAKTOR-VIII-ANTIGEN

Blood vessel invasion was investigated with haematoxylin-eosin (HE) staining and immunohistochemical staining for factor VIII antigen (F VIII) in 106 patients with primary carcinoma of the breast, in order to compare their value in prognosticating the probability of recurrence. Blood vessel invasion was diagnosed in 65 cases (61.9%) by HE, but in only 45 (43.4%) by F VIII staining. Lymph-node status and blood vessel invasion correlated positively on HE (r = 0.73; P = 0.0001), but not so on F VIII staining. Multivariate logistic regression showed blood vessel invasion to be a strongly independent prognostic factor for recurrence-free survival with F VIII staining (odds ratio: =7.19; P = 0.00001), while HE staining was not independent from other prognostic factors. These preliminary data thus suggest that demonstrating vascular invasion by F VIII staining may identify those patients with a very high risk of recurrence, independent of lymph-node status

Tumoral Microvessel Density in Breast-Cancer and its Influence On Recurrence-Free Survival

Angiogenesis quantitation of 106 patients with primary breast cancer and 35 patients with adenofibroma of the breast was compared and examined to its prognostic relevance for five-years disease-free survival in breast cancer patients. Immunocytochemical staining for Factor VIII-related antigen was performed to outline vascular endothelium. We found a significant higher vessel density in breast cancer patients who experienced recurrence (17.4) than in those with no recurrence (9.4) or with adenofibroma (8.7) [p < 0.0001]. The probability of five-years recurrence-free survical for patients with a primary tumor of high vessel density was at 52.3% and 86.4% for tumors of low microvessel density (p < 0.0011). Microvessel density proved to be an independent prognostic factor for breast cancer recurrence in the Cox-Model (relative risk 2.047, p = 0.0002)

The role of industry supervisors in providing feedback to students as part of the assessment process in Work Integrated Learning (WIL)

The workplace has been identified as providing a rich and rewarding source of learning for students. The provision of feedback is viewed as an integral part of assessing workplace learning or work integrated learning (WIL). However, the educational value of providing feedback to students by workplace supervisors on the full range of skills and competencies used in the professional setting has not been extensively studied. The practice of providing feedback to students from workplace supervisors clearly prevails both in Australia and more broadly in the international context, but documentation and research does not match the practice. Limited literature has been found on the process of providing feedback assessment by workplace supervisors, either formative or summative to students undertaking work-based learning. This study investigates best-practice models of industry feedback practices for WIL activities. These practices include the early involvement of students in defining goals/objectives and expectations with their supervisor; and clearly stated criteria for evaluating performance against the stated goals. The study builds on this prior literature to report desirable methods of workplace supervisor feedback that recognises ‘learning by doing’ through academic value attribution to data collected in the workplace. In particular, the study incorporates input from experienced industry supervisors in terms of defining their roles with students and academic mentors and delineating the criteria for student performance. A qualitative analysis of interviews with 15 industry supervisors of WIL students contributes to the body of knowledge on preferred modes for evaluating and reporting student performance. Sample feedback tools and guidelines which serve as models for industry supervisors are reported in the study. These feedback tools and guidelines fall within the broader context of holistic assessment processes for work integrated learning and provide educators with direction for effective engagement and feedback from industry supervisors

Influence of intratumoral basic fibroblast growth factor concentration on survival in ovarian cancer patients

Since basic fibroblast growth factor (bFGF) is considered as a potent mitogen that stimulates the growth of ovarian cancer cells, we evaluated the role of bFGF as a prognostic marker in patients with epithelial ovarian cancer. bFGF was quantified from the tumor cytoplasm of 76 patients with FIGO stage I-III ovarian cancer by a human FGF basic immunoassay (R&D Systems). After a mean follow-up period of 42 months, 50 patients were found to be free of tumor while 26 patients had died of the disease. The median bFGF concentration was 352.9 pg/mg (range 27.4-26 600 pg/mg). After dichotomization cytoplasmic expression of bFGF was found to be low in 44 tumors (less than or equal to 500 pg/mg) and high in 32 tumors (>500 pg/mg). The probability of overall survival was 38.8 and 58.5% in the low bFGF and high bFGF groups, respectively (log-rank P = 0.0066). In multivariate analysis, residual tumor after initial surgery and bFGF, but not histologic grade or stage of the disease, independently influenced the overall survival probability, Furthermore, tumors with high cytoplasmic expression of bFGF revealed a much greater stromal content. Therefore, we hypothesize that bFGF may induce a fibroblastic response which causes tumors with a high bFGF to be less aggressive than those with less stromal tissue. (C) 1998 Elsevier Science Ireland Ltd, All rights, reserved