Association between CT-Based Preoperative Sarcopenia and Outcomes in Patients That Underwent Liver Resections.

This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m <sup>2</sup> ) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m <sup>2</sup> , p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification

Organotypic Brain Cultures for Metastasis Research

We thank members of Brain Metastasis Group for critical discussion. Research in the Brain Metastasis Group is supported by MINECO-Retos SAF2017-89643-R (M.V.), Cancer Research Institute CLIP Award 2018 (M.V.), AECC (GCTRA16015SEOA) (M.V.), Bristol-Myers Squibb Melanoma Research Alliance Young Investigator Award 2017 (M.V.), Beug Foundation’s Prize for Metastasis Research 2017 (M.V.), Worldwide Cancer Research (19-0177) (M.V.), H2020-FETOPEN (828972) (M.V.), Fundación Ramón Areces (CIVP19S8163), and La Caixa-Severo Ochoa International PhD Program Fellowship (L.Z.). M.V. is a Ramón y Cajal Investigator (RYC-2013-13365) and an EMBO YIP investigator.N

Experiences with surgical treatment of ventricle septal defect as a post infarction complication

<p>Abstract</p> <p>Background</p> <p>Complications of acute myocardial infarction (AMI) with mechanical defects are associated with poor prognosis. Surgical intervention is indicated for a majority of these patients. The goal of surgical intervention is to improve the systolic cardiac function and to achieve a hemodynamic stability. In this present study we reviewed the outcome of patients with post infarction ventricular septal defect (PVSD) who underwent cardiac surgery.</p> <p>Methods</p> <p>We analysed retrospectively the hospital records of 41 patients, whose ages range from 48 to 81, and underwent a surgical treatment between 1990 and 2005 because of PVSD.</p> <p>Results</p> <p>In 22 patients concomitant coronary artery bypass grafting (CAGB) was performed. In 15 patients a residual shunt was found, this required re-op in seven of them. The time interval from infarct to rupture was 8.7 days and from rupture to surgery was 23.1 days. Hospital mortality in PVSD group was 32%. The mortality of urgent repair within 3 days of intractable cardiogenic shock was 100%. The mortality of patients with an anterior VSD and a posterior VSD was 29.6% vs 42.8%, respectively. All patients who underwent the surgical repair later than day 36 survived.</p> <p>Conclusion</p> <p>Surgical intervention is indicated for a majority of patients with mechanical complications. Cardiogenic shock remains the most important factor that affects the early results. The surgical repair of PVSD should be performed 4–5 weeks after AMI. To improve surgical outcome and hemodynamics the choice of surgical technique and surgical timing as well as preoperative management should be tailored for each patient individually.</p

Intra-abdominal hypertension due to heparin - induced retroperitoneal hematoma in patients with ventricle assist devices: report of four cases and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Elevated intra-abdominal pressure (IAP) has been identified as a cascade of pathophysiologic changes leading in end-organ failure due to decreasing compliance of the abdomen and the development of abdomen compartment syndrome (ACS). Spontaneous retroperitoneal hematoma (SRH) is a rare clinical entity seen almost exclusively in association with anticoagulation states, coagulopathies and hemodialysis; that may cause ACS among patients in the intensive care unit (ICU) and if treated inappropriately represents a high mortality rate.</p> <p>Case Presentation</p> <p>We report four patients (a 36-year-old Caucasian female, a 59-year-old White-Asian male, a 64-year-old Caucasian female and a 61-year-old Caucasian female) that developed an intra-abdominal hypertension due to heparin-induced retroperitoneal hematomas after implantation of ventricular assist devices because of heart failure. Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. A 36-year old female (the forth patient) presented with sudden, severe shortness of breath at rest, 10 days after an "acute bronchitis". At the time of the event in all cases international normalized ratio (INR) was <3.5 and partial thromboplastin time <65 sec. The patients were treated surgically, the large hematomas were evacuated and the systemic manifestations of the syndrome were reversed.</p> <p>Conclusion</p> <p>Identifying patients in the ICU at risk for developing ACS with constant surveillance can lead to prevention. ACS is the natural progression of pressure-induced end-organ changes and develops if IAP is not recognized and treated in a timely manner. Failure to recognize and appropriately treat ACS is fatal while timely intervention - if indicated - is associated with improvements in organ function and patient survival. Means for surgical decision making are based on clinical indicators of adverse physiology, rather than on a single measured parameter.</p

The Chemical Evolution of the La0.6Sr0.4CoO3−δ Surface Under SOFC Operating Conditions and Its Implications for Electrochemical Oxygen Exchange Activity

© The Author(s) 2018Owing to its extraordinary high activity for catalysing the oxygen exchange reaction, strontium doped LaCoO3 (LSC) is one of the most promising materials for solid oxide fuel cell (SOFC) cathodes. However, under SOFC operating conditions this material suffers from performance degradation. This loss of electrochemical activity has been extensively studied in the past and an accumulation of strontium at the LSC surface has been shown to be responsible for most of the degradation effects. The present study sheds further light onto LSC surface changes also occurring under SOFC operating conditions. In-situ near ambient pressure X-ray photoelectron spectroscopy measurements were conducted at temperatures between 400 and 790 °C. Simultaneously, electrochemical impedance measurements were performed to characterise the catalytic activity of the LSC electrode surface for O2 reduction. This combination allowed a correlation of the loss in electro-catalytic activity with the appearance of an additional La-containing Sr-oxide species at the LSC surface. This additional Sr-oxide species preferentially covers electrochemically active Co sites at the surface, and thus very effectively decreases the oxygen exchange performance of LSC. Formation of precipitates, in contrast, was found to play a less important role for the electrochemical degradation of LSC.Fonds zur Förderung der wissenschaftlichen Forschung (FWF)212921411

Tachyarrhythmiebedingte Synkopen. [Tachycardia-induced syncopes]

In 50% of the patients presenting with a syncope, the cause is cardiac. The incidence of sudden death with 24% is high in this group. Since most of the tachycardia-induced syncopes are due to ventricular tachycardia (VT), a careful diagnostic approach must be used. The possibility of a VT to end in a fibrillation is great, especially in the presence of a organic heart disease, which leads to a bad prognosis in such patients. The aim of a careful anamnesis and clinical history is to establish the presence of a cardiac disease. A Wolff-Parkinson-White syndrome, a long QT, an old myocardial infarction or a coronary artery disease (CAD) can be assessed by echocardiography (ECG). Stress testing is useful in evaluating a CAD and can possibly lead to a diagnosis when a VT or a supraventricular tachycardia (SVT) is induced. ECG is used to assess the cardiac ejection fraction and in the evaluation of a suspected right or left cardiomyopathy. The ambulatory ECG allow a diagnosis only in 2 to 3% of the cases. Nevertheless, the presence of more than 10 PVC/h and/or asymptomatic nonsustained VT is a predictor for sudden death in syncopy patients. Detection of late potentials has a sensitivity of 50 to 83% and a sensibility of 89 to 91% for the prediction of inducible sustained VT during electrophysiological studies (EPS) in patients with syncope. However, the usefulness of this technique is not fully established, since there is no significant difference in survival or recurrence of syncope between patients with and without late potentials. The EPS is an invasive technique and therefore used at the end of the investigations. The cardiovascular mortality is low (4%) in patients with a negative EPS. A treatment is mandatory in tachycardia-induced syncopes even when the cause is a SVT. Antiarrhythmic drugs are useful for the treatment of SVT. However, radiofrequency ablation of the accessory pathway is preferable, since the success rate is over 90%, and the side effects of chronic ingestion of antiarrhythmic drugs can therefore be avoided. Some VT can be treated successfully with drugs under the control of an EPS, but most of the patients must have the implantation of an internal cardiac defibrillator (ICD)

Pitting optic flow, object motion, and biological motion against each other

Heading estimation from optic flow is crucial for safe locomotion but becomes inaccurate if independent object motion is present. In ecological settings, such motion typically involves other animals or humans walking across the scene. An independently walking person presents a local disturbance of the flow field, which moves across the flow field as the walker traverses the scene. Is the bias in heading estimation produced by the local disturbance of the flow field or by the movement of the walker through the scene? We present a novel flow field stimulus in which the local flow disturbance and the movement of the walker can be pitted against each other. Each frame of this stimulus consists of a structureless random dot distribution. Across frames, the body shape of a walker is molded by presenting different flow field dynamics within and outside the body shape. In different experimental conditions, the flow within the body shape can be congruent with the walker’s movement, incongruent with it, or congruent with the background flow. We show that heading inaccuracy results from the local flow disturbance rather than the movement through the scene. Moreover, we show that the local disturbances of the optic flow can be used to segment the walker and support biological motion perception to some degree. The dichotomous result that the walker can be segmented from the scene but that heading perception is nonetheless influenced by the flow produced by the walker confirms separate visual pathways for heading estimation, object segmentation, and biological motion perception