Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery

Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988–1999. Of the patients, 76 (0.9%) developed sudden postoperative hemodynamic collapse resulting in subsequent emergency reopening of the median sternotomy and open cardiac massage. Further emergency reoperation could be performed in 62 (82%) whereas 14 patients died prior to reoperation and a further 21 did not survive the reoperation or died a few days later. All 35 (46%) patients who did not survive were subjected to medico-legal autopsy combined with postmortem cast angiography. By combining clinical data with autopsy and angiography data, various types of graft complications were observed in 27 (36%, 1.3 per patient) of the 76 patients with hemodynamic collapse. There were no significant differences in the frequency (33 vs. 40%) or number of complicated grafts per patient (1.2 vs. 1.4) between those who survived reoperation and who did not. Autopsy detected 25 major and minor findings not diagnosed clinically. Postmortem cast angiography visualized 2 graft twists not possible to detect by autopsy dissection only. Surgical graft complications were the most frequent single cause for sudden postoperative hemodynamic collapse in CABG patients leading to a fatal outcome in almost half of the cases. Postmortem angiography improved the accuracy of autopsy diagnostics of graft complications

The Cosmos in its Infancy: JADES Galaxy Candidates at z > 8 in GOODS-S and GOODS-N

We present a catalog of 717 candidate galaxies at $z > 8$ selected from 125 square arcminutes of NIRCam imaging as part of the JWST Advanced Deep Extragalactic Survey (JADES). We combine the full JADES imaging dataset with data from the JEMS and FRESCO JWST surveys along with extremely deep existing observations from HST/ACS for a final filter set that includes fifteen JWST/NIRCam filters and five HST/ACS filters. The high-redshift galaxy candidates were selected from their estimated photometric redshifts calculated using a template fitting approach, followed by visual inspection from seven independent reviewers. We explore these candidates in detail, highlighting interesting resolved or extended sources, sources with very red long-wavelength slopes, and our highest redshift candidates, which extend to $z_{phot} = 18$. We also investigate potential contamination by stellar objects, and do not find strong evidence from SED fitting that these faint high-redshift galaxy candidates are low-mass stars. Over 93\% of the sources are newly identified from our deep JADES imaging, including 31 new galaxy candidates at $z_{phot} > 12$. Using 42 sources in our sample with measured spectroscopic redshifts from NIRSpec and FRESCO, we find excellent agreement to our photometric redshift estimates, with no catastrophic outliers and an average difference of $\langle \Delta z = z_{phot}- z_{spec} \rangle= 0.26$. These sources comprise one of the most robust samples for probing the early buildup of galaxies within the first few hundred million years of the Universe's history.Comment: v2: 40 pages, 18 figures, submitted to AAS Journals, online data catalog (JADES Deep only) found at https://doi.org/10.5281/zenodo.809252

The Cosmos in its Infancy: JADES Galaxy Candidates at z > 8 in GOODS-S and GOODS-N

© 2024. The Author(s). Published by the American Astronomical Society. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/We present a catalog of 717 candidate galaxies at z > 8 selected from 125 square arcmin of NIRCam imaging as part of the JWST Advanced Deep Extragalactic Survey (JADES). We combine the full JADES imaging data set with data from the JWST Extragalactic Medium Survey and First Reionization Epoch Spectroscopic COmplete Survey (FRESCO) along with extremely deep existing observations from Hubble Space Telescope (HST)/Advanced Camera for Surveys (ACS) for a final filter set that includes 15 JWST/NIRCam filters and five HST/ACS filters. The high-redshift galaxy candidates were selected from their estimated photometric redshifts calculated using a template-fitting approach, followed by visual inspection from seven independent reviewers. We explore these candidates in detail, highlighting interesting resolved or extended sources, sources with very red long-wavelength slopes, and our highest-redshift candidates, which extend to z phot ∼ 18. Over 93% of the sources are newly identified from our deep JADES imaging, including 31 new galaxy candidates at z phot > 12. We also investigate potential contamination by stellar objects, and do not find strong evidence from spectral energy distribution fitting that these faint high-redshift galaxy candidates are low-mass stars. Using 42 sources in our sample with measured spectroscopic redshifts from NIRSpec and FRESCO, we find excellent agreement to our photometric redshift estimates, with no catastrophic outliers and an average difference of 〈Δz = z phot − z spec〉 = 0.26. These sources comprise one of the most robust samples for probing the early buildup of galaxies within the first few hundred million years of the Universe’s history.Peer reviewe

Factors associated with optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA non-detectability among HIV-positive crack cocaine users: a prospective cohort study

BACKGROUND: Crack cocaine use is known to contribute to poor adherence to antiretroviral medications; however, little is known about facilitators of or barriers to effective HIV treatment use among HIV-infected crack cocaine users. We sought to identify correlates of optimal pharmacy refill adherence for antiretroviral medications and plasma HIV RNA viral load (pVL) suppression among this population. METHODS: Data from a prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, were linked to comprehensive HIV clinical monitoring and pharmacy dispensation records. We used multivariable generalized linear mixed-effects modelling to longitudinally identify factors associated with ≥95 % adherence to pharmacy refills for antiretroviral medications and pVL <50 copies/mL among crack cocaine users exposed to highly-active antiretroviral therapy (HAART). RESULTS: Among 438 HAART-exposed crack cocaine users between 2005 and 2013, 240 (54.8 %) had ≥95 % pharmacy refill adherence in the previous 6 months at baseline. In multivariable analyses, homelessness (adjusted odds ratio [AOR]: 0.58), ≥daily crack cocaine smoking (AOR: 0.64), and ≥ daily heroin use (AOR: 0.43) were independently associated with optimal pharmacy refill adherence (all p < 0.05). The results for pVL non-detectability were consistent with those of medication adherence, except that longer history of HAART (AOR: 1.06), receiving a single tablet-per-day regimen (AOR: 3.02) and participation in opioid substitution therapies was independently associated with pVL non-detectability (AOR: 1.55) (all p < 0.05). CONCLUSIONS: Homelessness, and daily crack cocaine and/or heroin use were independently and negatively associated with optimal HAART-related outcomes. With the exception of opioid substitution therapies, no addiction treatment modalities assessed appeared to facilitate medication adherence or viral suppression. Evidence-based treatment options for crack cocaine use that also confer benefits to HAART need to be developed

Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved

Protein disulphide isomerase-assisted functionalization of proteinaceous substrates

Protein disulphide isomerase (PDI) is an enzyme that catalyzes thiol-disulphide exchange reactions among a broad spectrum of substrates, including proteins and low-molecular thiols and disulphides. As the first protein-folding catalyst reported, the study of PDI has mainly involved the correct folding of several cysteine-containing proteins. Its application on the functionalization of protein-based materials has not been extensively reported. Herein, we review the applications of PDI on the modification of proteinaceous substrates and discuss its future potential. The mechanism involved in PDI functionalization of fibrous protein substrates is discussed in detail. These approaches allow innovative applications in textile dyeing and finishing, medical textiles, controlled drug delivery systems and hair or skin care products.We thank to FCT 'Fundacao para a Ciencia e Tecnologia' (scholarship SFRH/BD/38363/2007) for providing Margarida Fernandes the grant for PhD studies