Skeletonized versus pedicled left internal mammary artery harvesting and risk of sternal wound infection after coronary artery bypass surgery

Background: The left internal mammary artery (LIMA) is the gold standard conduit for coronary artery bypass grafting (CABG). There are two harvesting methods, either pedicled or skeletonized. The choice of any technique must consider its complication profile, especially sternal wound infections (SWI). This study aims to evaluate and compare the occurrence of SWI after pedicled and skeletonized LIMA harvesting techniques for CABG. Methods: This prospective observational study included 300 patients who had CABG between 2016 and 2019. We included patients who had pedicled LIMA (n=200) in group 1 and who had skeletonized LIMA (n=100) in group 2. All patients completed a follow-up period of 3 months after CABG. The evaluation during follow-up included: sternal instability, signs of wound infection, temperature, the microbiological study of wound discharge, and chest computed tomography scan. Results: There was no significant differences in age (p = 0.20), male to female ratio (p = 0.43), body mass index (p = 0.12), NYHA I/II (p = 0.50), diabetes mellitus (p = 0.28), ejection  fraction (p= 0.14), and EuroSCORE II (p= 0.09) between groups. No significant difference in cardiopulmonary bypass time (p = 0.24), and cross-clamp time (p= 0.19) between groups. There was a significant increase in the total operating time in skeletonized LIMA group (212.77±75.25 min vs. 190.78±55 minutes, p= 0.004). Skeletonized LIMA was significantly associated lower incidence of SWI than that with pedicled LIMA (4% vs 15.5%, p= 0.003), and non-significantly lower incidence of deep SWI (1% vs 4.5%, p= 0.11). The risk factors for SWI in patients who had pedicled IMA were obesity (OR: 13.06, 95%CI: 3.98-42.89), diabetes mellitus (OR: 10.51, 95%CI: 2.35-46.84), and excessive diathermy (OR: 12.62, 95%CI: 3.93-40.54). Conclusion: Obesity, diabetes, and the use of excessive diathermy for hemostasis may increase the risk of sternal wound infection with pedicled LIMA harvest compared to skeletonized LIMA in patients undergoing CABG

STR-830: ENHANCING THE DEFORMATION CAPACITY OF CONCRETE SHEAR WALLS REINFORCED WITH GFRP BARS

An experimental study was recently conducted to address the applicability of concrete shear walls entirely reinforced with glass-fiber-reinforced polymer (GFRP) bars and subjected to quasi-static reversed cyclic lateral loading in attaining reasonable strength and drift requirements specified in different codes. The reported test results clearly show that properly designed and detailed GFRP-reinforced concrete (RC) walls could reach their flexural capacities with no strength degradation. The results also demonstrate that the tested walls were able to achieve recoverable and self-centering behavior up to allowable drift limits before experiencing moderate damage and attain a maximum drift comparable to steel-RC walls. The promising results provide impetus for constructing shear walls with GFRP bars and constitute a step toward using GFRP bars in lateral-resisting systems. Since enhancing concrete confinement at the boundary might be a solution in attempting to increase the deformation capacity of GFRP-RC shear walls without significant loss of strength, a series of shear walls were constructed with different reinforcement confinement configurations at the boundary zone. This paper compares the first tested shear wall to a previously reported shear wall (Mohamed et al 2014a). The results show a significant increase in lateral drift and strength of almost 79% and 27%, respectively, by doubling the confinement reinforcement ratio of the boundary. The seismic behavior of the wall was obviously improved, and the deformability level was significantly enhanced

STR-864: PROPOSED STRUT-AND-TIE MODEL FOR CONCRETE DEEP BEAMS REINFORCED WITH FRP BARS

A compiled database of 53 tests of FRP-reinforced concrete deep beams with shear span–depth ratios of less than two was used to evaluate the strut-and-tie models (STM) provided in ACI 318 (2014), CSA S806 (2012), CEB-fib (1999), and JSCE (2007). All provisions were found to be inadequate in calculating the capacity of FRP-reinforced deep beams due to inherent shortcomings in each provision. Hence, a new STM-based procedure for FRP-reinforced deep beams was proposed. The new model incorporates the effect of shear span–depth ratio (a/d), concrete compressive strength (fc’), and tensile strain in the adjoining tie (ε1). The contribution of the web reinforcement on the strut efficiency factor was found to be insignificant. The new model was capable of predicting the ultimate capacity of the compiled FRP-reinforced concrete deep beams with satisfactory conservatism

Effect of salinity and sodicity stresses on physiological response and productivity in Helianthus annuus

Soil salinity and sodicity (alkalinity) are serious land degradation issues worldwide that are predicted to increase in the future. The objective of the present study is to distinguish the effects of NaCl and Na2CO3 salinity in two concentrations on the growth, lipoxygenase (LOX) activity, membrane integrity, total lipids, yield parameters and fatty acids (FAs) composition of seeds of sunflower cultivar Sakha 53. Plant growth, LOX activity and malondialdehyde (MDA) content were reduced by salts stresses. On the contrary, salinity and alkalinity stress induced stimulatory effects on membrane permeability, leakage of UV-metabolites from leaves and total lipids of sunflower shoots and roots. Crop yield (plant height, head diameter, seed index and number of seeds for each head) that is known as a hallmark of plant stress was decreased by increasing concentrations of NaCl and Na2CO3 in the growth media. Fatty acid methyl esters (FAME) composition of salt-stressed sunflower seeds varied with different levels of NaCl and Na2CO3

Blood Pressure and Blood Pressure Deficits as Predictors of Acute Kidney Injury in Vasopressor Dependent Patients Post Cardiovascular Surgery

BACKGROUND: Acute kidney injury (AKI) is a common and serious post-operative complication following cardiovascular surgery. AIM: The aim of the study was to evaluate the value of blood pressure and blood pressure deficits as predictors of AKI in post cardiovascular surgery vasopressors’ dependent patients. METHODS: A prospective observational, single center study, conducted on 100 patients requiring vasopressor support for more than 4 h after cardiovascular surgery. All included patients were subjected to the measurements of three or more systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) readings from the ward charts before surgery and the mean of these measures was calculated, was recorded and pre-operative systolic perfusion pressure (SPP), diastolic perfusion pressure (DPP), and mean perfusion pressure (MPP) were calculated. A vasopressor-associated average values for hemodynamic pressure-related parameters (SAP, DAP, MAP, CVP, SPP, DPP, and MPP) were calculated on the 1st 24 h after admission. The percent deficit in post-operative average parameters in relation to pre-operative parameters was determined as % parameter deficit. RESULTS: The pre-operative SAP, DAP, MAP, SPP, DPP, and MPP were significantly higher in the non-AKI compared to AKI patients while pre-operative central venous pressure (CVP) was significantly higher in AKI patients. The post-operative DAP, MAP, DPP, and MPP were also higher in non-AKI and the post-operative CVP was lower in non-AKI compared to AKI patients. CONCLUSIONS: This study concluded that the relative decrease in the perfusion pressures could be significant predictors of AKI after cardiovascular surgery in vasopressor dependent patients. The higher pre- or post-operative CVP or its relative decrease after cardiac surgery was seen also to be associated with higher incidence of AKI

STRESS ANALYSIS COMPARING EFFECT OF TWO DIFFERENT CAD-CAM IMPLANT SUPERSTRUCTURE MATERIALS (IN-VITRO STUDY)

Purpose: This study was conducted to evaluate the micro-strain around dental implant using two different CAD/CAM crown fabricated materials through strain gauge analysis. Materials and Methods: Five dental implants were fixed in a 5 previously drilled solid rigid polyurethane test blocks in the edentulous area with neighboring abutments mesial and distal printed out using special 3D Dental printer, Cyanoacrylate adhesive was then used to fix the printed-out part on to the polyurethane test blocks, creating the bounded saddle replicas. Ten CAD/CAM screw retained crowns were fabricated; five Enamic crowns from vita enamic blocks, and five zirconia crowns from presintered katana zirconium blocks. Each crown was cemented to abutment and screwed over the implant fixture. Two strain gauges were installed on their corresponding prepared sites to measure the micro-strains in the medium surrounding the implant. For each tested implant, loads were applied by a universal testing machine, micro-strains were recorded with the strain gauges and stress distribution around the implant was statistically evaluated. Results: Micro-strain recording revealed a statistically significant difference in mean micro-strain recording applied in central fossa between Zirconia and Enamic, for both the buccal and lingual measurements, Enamic was significantly lower than Zirconia. Conclusion: The modulus of elasticity of restorative materials has a meaningful effect on forces applied to dental implant and transmitted to the supporting bone

Safety and efficacy of venous mechano-chemical ablation of the great saphenous vein

Introduction: Endovenous mechano-chemical ablation of the incompetent great saphenous vein (MOCA) is a new technique that combines mechanical endothelial injury and infusion of a sclerosant agent. Material and methods: This is a prospective study was conducted on 40 patients who presented with the chronic venous disease at Kasr Al Ainy outpatient vascular surgery clinic with CEAP classification namely C2-C6. Results: A total of 40 patients were presented with great saphenous vein incompetency, the mean age was (30), 23 patients were male and 17 were female. The vein occlusion rate at one month was 93 percent and at six months was 87 percent respectively. Conclusions: Endovenous mechanochemical ablation is a safe and effective method for the management of incompetent great saphenous veins compared to open surgery

Post-Thoracotomy Pain: Review Article

Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life?Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century