Topical rifampicin for prevention of deep sternal wound infections in patients undergoing coronary artery bypass grafting

Deep sternal wound infections (DSWI), although an infrequent complication, significantly impair postoperative outcomes after coronary artery bypass grafting (CABG) surgery. Among several preventive strategies, topical antibiotic therapy immediately before sternal closure has been strongly advocated. In this retrospective analysis, the incidence of DSWI in 517 patients undergoing isolated CABG and receiving rifampicin irrigation of mediastinum, sternum and suprasternal tissues was compared to an historical consecutive cohort of 448 patients. To account for the inherent selection bias, a 1:1 propensity matched analysis was performed. Patients receiving topical rifampicin experienced significantly less occurrence of postoperative DSWI (0.2% vs 2.5%, p = 0.0016 in the unmatched analysis; 0.3% vs 2.1%, p = 0.0391 in the matched analysis). Intensive care unit stay, hospital stay, and operative mortality were similar between groups. This study shows that topical rifampicin in combination with commonly prescribed preventative strategies significantly reduces the incidence of DSWI to less than 0.3% in unselected patients undergoing a full median sternotomy for CABG. Further studies, including a larger number of patients and with a randomization design, would establish the potential preventative role of topical rifampicin in reducing the occurrence of DSWI

Horizon 2020 Societal Challenge 2 \u201cFood Security, Sustainable Agriculture and Forestry, Marine, Maritime and Inland Water Research, and the Bioeconomy\u201d Advisory Group Recommendations Programming Period 2018-2020

The Horizon 2020 Societal Challenge 2 Programme was created to develop and implement an EU research and innovation policy for more sustainable and resource efficient agriculture, forestry, inland water and marine systems that supply European society with sufficient food, feed, biomass, and other raw materials, as well as ecosystems services, and support thriving rural and coastal livelihoods. The European Commission has established Societal Challenge Advisory Groups to provide consistent and consolidated advice - by way of opinions, recommendations and reports - on relevant research objectives and scientific, technological and innovation priorities for its strategic and annual work programmes. Our Societal Challenge 2 Advisory Group includes a wide range of members with remarkably rich and diverse backgrounds and affiliations, including researchers, academics, former policymakers - stakeholders covering the whole spectrum of relevant research and innovation domains. Our Advisory Group has met twice formally since our establishment in February 2016, and has used other opportunities for extensive discussion and engagement on the issues surrounding this Societal Challenge. We see Societal Challenge 2 as not only extremely important as a challenge in itself, but also strongly linked with other Societal Challenges such as health, demographic change and wellbeing, climate action, environment, resource efficiency and raw materials, and inclusive, innovative and reflective societies in a changing world. And as the agriculture, forestry, fisheries and food sectors comprise a very large number of smaller businesses \u2013 themselves serving large scale processing and retail business sectors \u2013 there are strong links between our contribution and the input of groups advising on innovation in small and medium-sized enterprises, international cooperation, nanotechnologies, advanced materials and advanced manufacturing and processing. Our Advisory Group\u2018s first task has been to prepare this report to answer five specific questions posed by the Commission and provide input into the strategic programming cycle of the Work Programme for 2018-2020. We have identified some overriding strategic priorities, and backed those with the results of a more detailed analysis of the gaps that need to be addressed. And we highlight the cross-cutting nature of this programme and the importance of an integrated approach to maximise the overall impact of the current Horizon 2020 programme. We hope that the insights in this report may also assist in the identification and prioritisation of research needs and strengthen the Commission\u2018s strategic and impact-oriented approach in future years

On the stability of portfolio selection models

One of the main issues in portfolio selection models consists in assessing the effect of the estimation errors of the parameters required by the models on the quality of the selected portfolios. Several studies have been devoted to this topic for the minimum variance and for several other minimum risk models. However, no sensitivity analysis seems to have been reported for the recent popular Risk Parity diversification approach, nor for other portfolio selection models requiring maximum gain-risk ratios. Based on artificial and real-world data, we provide here empirical evidence showing that the Risk Parity model is always the most stable one in all the cases analyzed with respect to the portfolio composition. Furthermore, the minimum risk models are typically more stable than the maximum gain-risk models, with the minimum variance model often being the preferable one. The Risk Parity model seems to be the most stable one also with respect to profitability when measured by the Sharpe ratio. However, the maximum gain-risk models, although quite sensitive to the input data, generally appear to attain better profitability results

Age and blood transfusion: relationship and prognostic implications in cardiac surgery

Red blood cell (RBC) transfusion is a well-known predictor of acute kidney injury (AKI) and death after cardiac surgery. This study aimed to define the relationship between age and the need for RBC

Severe prosthesis-patient mismatch after aortic valve replacement for aortic stenosis: Analysis of risk factors for early and long-term mortality

Background Severe prosthesis-patient mismatch (PPM) is considered to further decrease survival compared to moderate PPM. This study aimed to assess the impact of severe PPM on survival after aortic valve replacement (AVR). Methods We retrospectively studied 2404 consecutive patients with PPM who underwent first-time AVR for pure stenosis between January 2003 and December 2014. Mismatch was moderate for indexed effective valve orifice >0.65 to 220 g/m2 and concomitant coronary artery revascularization. After propensity score matching, conditional logistic regression analysis demonstrated no relationship between severe mismatch and increased mortality at 5 postoperative years (HR, 0.9; 95% CI, 0.7–1.6; p = 0.06), whereas it was significant at 10 postoperative years (HR, 1.9; 95% CI, 1.2–2.5; p = 0.03). During the follow-up, severe mismatch was associated with more frequent hospital readmissions for cardiac events (0.12 vs. 0.08 events/patient/year, p = 0.007). Conclusions Patients with severe mismatch had lower long-term survival and higher incidence of hospital readmissions for cardiac events. However, the effect of severe mismatch on outcome appeared mainly related to the preoperative risk profile of each patient. © 2016 Japanese College of Cardiolog