Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study

<p>Abstract</p> <p>Background</p> <p>Atrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality. The effect of postoperative AF on long-term survival however has not been studied. Our aim was to evaluate the impact of AF on early outcome and on survival > 5 years after pulmonary lobectomy for lung cancer.</p> <p>Methods</p> <p>From 1996 to June 2009, 454 consecutive patients undergoing lobectomy for lung cancer were enrolled and followed-up until death or study end (October 2010). Patients with postoperative AF were identified; AF was investigated with reference to its predictors and to short- and long-term survival (> 5 years).</p> <p>Results</p> <p>Hospital mortality accounted for 7 patients (1.5%), while postoperative AF occurred in 45 (9.9%). Independent AF predictors were: preoperative paroxysmal AF (odds ratio [OR] 5.91; 95%CI 2.07 to 16.88), postoperative blood transfusion (OR 3.61; 95%CI 1.67 to 7.82) and postoperative fibro-bronchoscopy (OR 3.39; 95%CI 1.48 to 7.79). Patients with AF experienced higher hospital mortality (6.7% vs. 1.0%, p = 0.024), longer hospitalization (15.3 ± 10.1 vs. 12.2 ± 5.2 days, p = 0.001) and higher intensive care unit admission rate (13.3% vs. 3.9%, p = 0.015). The median follow-up was 36 months (maximum: 179 months). Among the 445 discharged subjects with complete follow-up, postoperative AF was not an independent predictor of mortality; however, among the 151 5-year survivors, postoperative AF independently predicted poorer long-term survival (HR 3.75; 95%CI 1.44 to 9.08).</p> <p>Conclusion</p> <p>AF after pulmonary lobectomy for lung cancer, in addition to causing higher hospital morbidity and mortality, predicts poorer long-term outcome in 5-year survivors.</p

Production of benzaldehyde, benzyl alcohol and benzoic acid by yeasts and Botrytis cinerea isolated from grape musts and wines

The capacity of 100 yeast strains - isolated from grape musts and wines from the Istituto Sperimentale per l'Enologia collection - to produce benzaldehyde, benzyl alcohol and benzoic acid was verified by inoculation into a synthetic nutrient medium (MNS). Schizosaccharomyces and Zygosaccharomyces were strongest in producing benzaldehyde (maximal amount found 1200 µg/l) and benzyl alcohol (maximally 523 µg/l). Zygosaccharomyces was also most effective in the production of benzoic acid (maximally 536 µg/l), followed by Saccharomyces, Cryptococcus, Kloeckera and Torulaspora. The hypothesis was verified that yeasts can be an exogenous source of the benzyl alcohol oxidizing enzyme in grape musts and wines. Wine yeast strains of Saccharomyces spp., Zygosaccharomyces spp. and Schizosaccharomyces spp. fermenting MNS containing 150 g/l glucose, with benzyl alcohol added, transformed this into benzoic acid only when glucose was disappearing, but not into benzaldehyde. No difference was observed between aerobic and anaerobic fermentation conditions. The uptake of benzyl alcohol was rapid in fermentation essays in presence of only 10 g/l glucose and in assimilation essais performed in yeast nitrogen base broth with assimilable carbon compounds added. A catabolic repression by glucose appears likely. Botrytis cinerea was able to transform benzyl alcohol into benzaldehyde and benzoic acid on Czapek-Dox broth with 30 g/l sucrose added. Benzyl alcohol was transformed by wine yeasts into benzoic acid when the concentration of glucose in the mineral medium was less than 10 g/l, but no production of benzaldehyde was observed. A catabolic repression of this transformation by glucose is likely. Botrytis cinerea was able to produce benzaldehyde in a mineral medium with benzyl alcohol and sucrose added

THE BASE SYSTEM: A SCHOOL-WIDE POSITIVE BEHAVIOUR SUPPORT TOOL TO FACILITATE EVIDENCE-BASED DIGITAL INTERVENTION PRACTICES

The Positive Behaviour Intervention and Support system is a framework aimed to introduce a change at school-wide level. It promotes a disciplinary system change process, from a reactive punishment- based strategies of specific student misbehaviours to a proactive system, where different behavioural principles such as the modelling and reinforcement of positive prosocial students’ behaviours are applied to improve school values and to create a positive climate. This paper presents the Behavioural Assessment to improve School Environment (BASE) system and the BASE repository. The BASE system supports evidence-based digital intervention practices for stimulating the academic, social, emotional, and behavioural competencies of all students. The BASE repository is a collection of good practices, tools, and instructional contents. Both of the tools are able to support and facilitate, through the use of mobile devices and a web-based responsive system, different prevention and instructional practices at the three-tiers PBS model. At the first level of prevention (Tier 1) the system allows to the school PBS team to define the Expectation Matrix, a set of positive behaviours grouped according to predefined school values and locations. Moreover, the PBS team members are able to define the list of problem behaviours, classifying them in minor and major. The matrix and the list of minor and major problem behaviours are at the base of the development of a screening tool for identifying behavioural risk problems, the Positive Office Referral and the Office Disciplinary Referral tools. At the target prevention level (Tier 2) the BASE application provides the Check-in/Check-out (CICO) tool, as PBIS recommends. It is addressed to a targeted group of students, resulted unresponsive to the Tier I, and implements the practice of ‘Positive reinforcement contingent on meeting behavioural goals’ throughout a reward system. At the intensive prevention level (Tier 3) the system allows users to perform Functional Behaviour Assessment for students considered unresponsive to Tier I and II and to create customized measurement tools for designing single case studies. The measure can be assigned to the observers able to collect data and organize them in phases. A TAU analysis algorithm is applied to the gathered data for showing the effectiveness of intervention. In the BASE application, each student can access to the system with personal credentials and to visualize his significant progresses into a smart dashboard. The BASE repository represents a hub for digital resources collection concerning both theoretical and methodological aspects of the PBIS approach. The Internet users interested to know the European experience of the involved partner schools, and to enlarge their knowledge about the principles to implement the PBIS in their own school, can find a first set of multimedia contents, webinars, collection of good practices gathered during the lifespan of the European Erasmus+ BASE project. The repository facilitates the finding of high-quality contents and represents a learning corner and an important knowledge repository for teachers and health professionals to understand and apply this approach

Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in the Management of Perioperative Bleeding after Coronary Artery Bypass Grafting

Background and Aim: Recent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery. The benefits and risks associated with the use of PCC over FFP have been investigated in this study including patients undergoing isolated coronary artery bypass grafting(CABG) from a prospective, multicenter registry. Methods: This is a comparative analysis of 416 patients who received postoperatively FFP and 119 patients who received PCC with or without FFP after isolated CABG. Results: Mixed-effects regression analyses adjusted for multiple covariates and participating centers showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136-0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097-0.566) compared with FFP. The PCC cohort received a mean of 2.7\ub13.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9\ub16.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, -1.926, 95%CI -3.357-0.494). The use of PCC increased the risk of KDIGO acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203-4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258-2.796) when compared with the FFP cohort. Conclusions: These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG. In view of the observational nature of this study, these results shoul

Durability of bioprosthetic aortic valves in patients under the age of 60 years - Rationale and design of the international INDURE registry

Background: There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. Methods: The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INSPIRIS RESILIA aortic valve. INDURE will be conducted across 20-22 sites in Europe and Canada and intends to enrol minimum of 400 patients. Patients will be included if they are scheduled to undergo AVR with or without concomitant root replacement and/or coronary bypass surgery. The primary objectives are to 1) determine VARC-2 defined time-related valve safety at one-year (depicted as freedom from events) and 2) determine freedom from stage 3 structural valve degeneration (SVD) presenting as morphological abnormalities and severe haemodynamic valve degeneration at 5 years. Secondary objectives include the assessment of the haemodynamic performance of the valve, all stages of SVD, potential valve-in-valve procedures, clinical outcomes (in terms of New York Heart Association [NYHA] function class and freedom from valve-related rehospitalisation) and change in patient quality-of-life. Discussion: INDURE is a prospective, multicentre registry in Europe and Canada, which will provide much needed data on the long-term performance of bioprosthetic valves in general and the INSPIRIS RESILIA valve in particular. The data may help to gather a deeper understanding of the longevity of bioprosthetic valves and may expand the use of bioprosthetic valves in patients under the age of 60 years. Trial registration: ClinicalTrials.gov identifier: NCT03666741 (registration received September, 12th, 2018)

Value of Screening Asymptomatic Carotid Artery Stenosis Prior to Coronary Artery Bypass Grafting: Analysis of the E-CABG Registry

Background and aim: The aim of this study was to evaluate the prognostic impact of asymptomatic carotid artery stenosis(CAS) in patients undergoing isolated coronary artery bypass grafting(CABG). Methods:Patients from the multicenter, prospective E-CABG registry without history of stroke or transient ischemic attack and screened by duplex ultrasound for CAS before isolated CABG were included in this analysis. Results:Among 2813 patients screened by duplex ultrasound for asymptomatic CAS, 11.1% had a CAS of 50-59%, 6.0% of 60-69%, 3.1% of 70-79%, 1.4% of 80-89%, 0.5% of 90-99%, and 1.1% had carotid occlusion. Postoperative stroke occurred in 25 patients(0.9%). Lesions were bilateral in five patients(25%) and ipsilateral to a CAS 6550% in six patients(30%). In univariate analysis, the severity of CAS was associated with a significantly increased risk of stroke(p&lt;0.0001). In multivariate analysis, a CAS of 90-99%(OR 12.03, 95%CI 1.34-108.23) and the presence of an occluded internal carotid artery(OR 8.783, 95%CI 1.820-42.40) were independent predictors of stroke along with urgency of the procedure, severe-massive bleeding according to the E-CABG classification and the presence of a porcelain ascending aorta. Conclusions: Among patients with asymptomatic CAS, the risk of stroke is significant only in patients with a stenosis 6590%. Since this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, preoperative screening of asymptomatic CAS before CABG may not be justified. Instead, avoiding manipulation of diseased ascending aorta and prevention of excessive bleeding may be more effective measures to prevent stroke after CABG