Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery Safety and efficacy

AbstractObjectivesWe sought to determine whether limited left atrial Maze surgery encircling each of the pulmonary veins, using cooled-tip radiofrequency (RF) ablation, is as effective as the bi-atrial approach?BackgroundThe original Cox/Maze operation effectively restores sinus rhythm (SR) in patients with atrial fibrillation (AF). Ablation procedures aimed at eliminating pulmonary vein foci have produced promising short-term success.MethodsThis was a prospective analysis of patients with chronic AF undergoing open-heart surgery in addition to the Maze operation, using intraoperatively cooled-tip RF ablation either in the left atrium alone (group A) or in both atria (group B).ResultsPatients in group A (n = 21) and group B (n = 49) did not differ in terms of their baseline characteristics. Concomitant open-heart surgical procedures included mitral valve replacement (3 vs. 25), mitral valve plasty (0 vs. 2), mitral and aortic valve replacement (1 vs. 1), aortic valve replacement (4 vs. 6) and coronary artery bypass grafting (13 vs. 15) in groups A and B, respectively. Follow-up ranged from 1 to 50 months. The overall cumulative rates of SR were 82% in group A and 75% in group B, without a statistically significant difference (p = 0.571). Bi-atrial contraction was revealed in 92.3% of patients in SR in group A and in 79.2% in group B. The cumulative survival rates were 90.5% in group A and 77.9% in group B (p = 0.880).ConclusionsA left or bi-atrial Maze operation using intraoperatively cooled-tip RF ablation can safely be combined with open-heart surgery. A left atrial Maze procedure seems to be as effective as the bi-atrial procedure and restores SR in 82% of patients

Thrombin generation in patients with a bleeding tendency of unknown origin

International audienceThere are a number of persons with a mild to moderate bleeding tendency, in whom no underlying bleeding disorder can be detected despite thorough investigation of all known heritable and acquired haemostatic abnormalities. Thrombin is the central enzyme in the coagulation cascade, which is important for sufficient haemostasis. The measurement of an individual's potential to generate thrombin has been proposed for estimating the individual coagulation potential and predicting a hyper- or hypo-coagulable phenotype. The aim of our study was to investigate in vivo thrombin generation in a case-control study of patients with a bleeding tendency of unknown origin and in age- and sex-matched healthy individuals. Bleeding tendency was classified according to a standardized bleeding score. Thrombin generation was measured with a commercially available assay (Technothrombin-TGA, Technoclone, Vienna, Austria). In total, 101 patients (76 female; median age [25th-75th percentile], 44 [35-60] years) and 102 controls (67 women; median age, 47 [38-55] years) were enrolled. The distribution of parameters of thrombin generation among patients and controls showed no statistically significant difference: lag phase (14.4 [11.1-18.1] vs. 14.1 [12.1-17.1] min,  = 0.720), peak thrombin (179.8 [135.6-242.6] vs. 175.1 [143.1-261.4] nM,  = 0.576), time to peak thrombin (23.6 [18.1-28.6] vs. 22.6 [18.6-27.1] min,  = 0.790), velocity index (19.7 [13.0-39.0] vs. 22.6 [14.5-36.5] nM/min,  = 0.233) and area under the thrombin generation curve (3,491 [3,069-3,880] vs. 3,414 [3,045-3,750] nM thrombin,  = 0.673). In conclusion, the thrombin generation potential in patients with a bleeding tendency of unknown origin was not different from that of healthy individuals

E-procurement in Public Organization

Tampereen kaupungin kokonaishankinnoista vain kaksi prosenttia tehtiin toiminnanohjausjärjestelmällä vuonna 2013. Järjestelmän matalasta käyttöasteesta johtuen hankintatiedot puuttuvat järjestelmästä, mikä hankaloittaa hankintojen strategista johtamista. Työn taustalla on tarve tehostaa toimintoja ja saada aikaan kustannussäästöjä sekä saada hankinnoista enemmän tietoa niiden tehokkaammaksi johtamiseksi. Tutkimuksen tarkoituksena oli tunnistaa keinoja, joiden avulla Tampereen kaupungin ostamista voidaan kehittää sähköisellä ostojärjestelmällä. Päätavoitteena oli kaupungin ostamisen nykytilan selvittäminen ja siihen soveltuvan sähköisen ratkaisun vaatimusten määrittely. Tässä työssä keskityttiin työn toimeksiantajan Tampereen Logistiikan valitsemien Tampereen kaupungin yksiköiden Infran, Kotihoidon ja Tilakeskuksen ostamisen kehittämiseen. Tutkimus toteutettiin laadullisena monimenetelmäisenä tapaustutkimuksena. Aineistona käytettiin kirjallisuutta, vanhoja Tampereen kaupungin selvityksiä sekä kohdeyksiköiden ja muiden kaupunkien hankinnoista vastaavien henkilöiden haastatteluja. Aikaisempi kirjallisuus on käsitellyt ostamisen suhdetta hankintoihin ja toimitusketjuun sekä tarkastellut sähköistä ostamista keinona tehostaa hankintoja. Tutkimuksen empiriaosuus esittelee ensin havaintoja aikaisemmista tutkimuksista sekä muiden kaupunkien benchmark-analyysistä. Toisessa osassa käsitellään ostotoimintaa ja sen kehitysmahdollisuuksia kohdeorganisaation valikoiduissa yksiköissä. Aineistoanalyysin tuloksena tunnistettiin ostamisen ongelmaksi kirjavat ostoprosessit sekä niistä aiheutuvat prosessikustannukset. Tuloksina saatiin ostamisen asettamia vaatimuksia ostojärjestelmälle, joita ovat noutojen kirjaus ja mobiilikäyttömahdollisuus. Ratkaisuehdotuksena annettiin malli uudesta prosessista, johon sitoutuu vähemmän työaikaa aikaisempaan verrattuna sekä ehdotettiin katalogien käyttöönottamista kaupungin omassa järjestelmässä

Therapeutic drug monitoring in adolescents with anorexia nervosa for safe treatment with adjunct olanzapine

Objective: Medication is commonly used in anorexia nervosa (AN) despite largely missing high grade evidence. Olanzapine (OLZ) is the best-evidenced substance used off-label in this group, with conflicting outcome regarding BMI, clinical and safety parameters. Therefore, it is important to strictly assure quality of treatment with OLZ in AN by using 'Therapeutic Drug Monitoring' according to AGNP-guidelines, including serum levels and adverse drug reactions (ADRs) to support safety for adolescents with AN and attempt to generate an initial age- and disorder-specific therapeutic reference range. Method: Sixty-five adolescents with AN (aged 10-18) treated with OLZ (98% female; 97.5% AN-restricting-type) were prospectively observed, ADRs reported, and correlations between dosage and serum levels measured at trough level were calculated, a preliminary therapeutic range defined. Results: Mean dosage of OLZ was 8.15 (SD: 2.91) mg and 0.19 (SD: 0.07) mg/kg respectively, average concentration was 26.57 (SD: 13.46) ng/mL. Correlation between daily dosage/dosage per kg and serum level was 0.72 (**p < 0.001)/0.65 (**p < 0.001), respectively. ADRs with impairment were rare (6.3%). 75% improved clinically (CGI). BMI increased significantly by 1.5 kg/m2 (t = 10.6, p < 0.001). A preliminary therapeutic reference range is 11.9 and 39.9 ng/mL. Conclusions: OLZ in the hands of specialists is a well-tolerated and safe treatment adjunct for adolescents with AN

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism

Attachment styles hold important downstream consequences for mental health through their contribution to the emergence of self-criticism. To date, no work has extended our understanding of the influence of attachment styles on self-criticism at a neurobiological level. Herein we investigate the relationship between self-reported attachment styles and neural markers of self-criticism using fMRI. A correlation network analysis revealed lingual gyrus activation during self-criticism, a marker of visual mental imagery, correlated with amygdala activity (threat response). It also identified that secure attachment positively correlated with lingual gyrus activation, whilst avoidant attachment was negatively correlated with lingual gyrus activation. Further, at greater levels of amygdala response, more securely attached individuals showed greater lingual gyrus activation, and more avoidantly attached individuals showed less lingual gyrus activation. Our data provide the first evidence that attachment mechanisms may modulate threat responses and mental imagery when engaging in self-criticism, which have important clinical and broader social implications.Australian Postgraduate Scholarship

De l'Orme rendszerű deszkaíves térlefedések Magyarország újkori templomépítészetében

A tanulmány - a magyarországi evangélikus templomokkal foglalkozó építészettörténeti kutatás kapcsán - rövid áttekintést kíván adni a faszerkezetű boltozattípusokról, különös tekintettel a hazánkban a XVIII. századtól egészen a XX. század elejéig épült - és főként a templomépítészetben elterjedt - ún. de l'Orme-rendszerű deszkaíves térlefedésekről. Az elnevezés Philibert de l'Orme francia építészre utal, aki az 1561-ben megjelent „Nouvelles inventions pour bien bastir et a petits fraiz” c. művében ismertette e szerkezetet és javaslatokat adott különböző gyakorlati alkalmazási lehetőségeire. Az ilyen ívtartók függőlegesen egymás mellé helyezett és eltolással toldott deszkákból (vastagság 2-3 cm) vagy pallókból (vastagság 3,5-6 cm) állnak. Magyarországra minden valószínűség szerint német nyelvterületről került be a szerkezettípus.  A megvalósult szerkezetek funkció, forma, tartószerkezet, épületszerkezeti kialakítás szempontjából változatosak; a XIX. századi magyarországi templomépítészetben viszonylag nagy számban előfordulnak