Tracheal cryopreservation: caspase-3 immunoreactivity in tracheal epithelium and in mixed glands

Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196°C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising

Lyophilized glutaraldehyde-preserved bovine pericardium for experimental atrial septal defect closure

A variety of patch materials has been used to close large atrial septal defects (ASD). Autologous pericardium and glutaraldehyde-preserved bovine pericardium are the most used. Lyophilized bovine pericardium has not been tested inside the cardiovascular system. The aim of this work was to study the behaviour and effectiveness of lyophilized glutaraldehyde-preserved bovine pericardium in ASD closure. Sixteen mongrel dogs were operated on. A 3 cm diameter atrial septal defect was created, and closed with: Group I (n=8): Lyophilized glutaraldehyde preserved bovine pericardium (LGPBP). Group II (n=8): Vascular Dacron patch. The animals were evaluated clinically, by echocardiography, macroscopically, and microscopically. Statistical analysis was done with analysis of variance (ANOVA) and Student’s t-test. All the animals survived the surgical procedure and study time (6 months). Clinically all the animals displayed normal physical activity, with normal cardiac sounds. Echocardiography showed that both groups had a normal heart without intracardiac shunts, no thrombus formation, and no vegetations. Macroscopically all the animals showed good integration of the lyophilized bioprosthesis and Dacron patch. All group I animals presented a decrease of the area of the ASD in the left atrium (p<0.001 by ANOVA and Student’s t-test). Microscopically, group I presented dense and well-organized collagenous tissue, areas of cartilaginous metaplasia and remnants of the lyophilized bioprosthesis (p<0.001 by ANOVA and Student’s t-test). Group II showed encapsulated Dacron patch covered with collagenous tissue and cartilaginous metaplasia. In conclusion, the new lyophilized bioprosthesis is well integrated into the atrial septum, without complications and is effective for ASD closure

Recomendaciones específicas para enfermería sobre el proceso de terapia endovenosa

Intravenous therapy includes among other actions, the installation procedures, handling and retirement of the catheter, procedures that the nurses carries out in a frequent way in the institutions of health. Nurses intervenes in the doctortherapeutic plan and they are responsible for maintaining a level of experience and specific knowledge to provide the necessary cares indicated in the therapeutic plan and in attention to the conditions of each patient. Derived of the Recommendations to improve attention in nursing, these specific recommendations are emitted related with the intravenous therapy, directed to prevent conflicts in the nursing attention and to improve the communication with the patient. Due to the importance of this topic National Medical Arbitration Commission of Mexico (CONAMED) and the External Validation Group coordinated by the Nursing Interinstitutional Commission of Mexico, emit these recommendations: 1) Establish a good nurse-patient relationship; 2) Avoid complications in the catheter installation; 3) Watch over the intravenous therapy to prevent complications; 4) Move away the catheter avoiding risks in the physical integrity of the patients and 5) Diminish the risk factors for the intravenous therapy responsible personnel.La terapia endovenosa incluye entre otros, los procedimientos de instalación, manejo y retiro del catéter, procedimientos que el personal de enfermería realiza de manera frecuente en las instituciones de salud. El personal de enfermería interviene en el plan médico-terapéutico y es responsable de mantener un nivel de experiencia y conocimientos específicos para proporcionar los cuidados necesarios indicados en el plan terapéutico y en atención a las condiciones particulares de cada paciente. Derivado de las Recomendaciones para mejorar la atención en enfermería, se emiten estas recomendaciones específicas relacionadas con la terapia endovenosa, estas recomendaciones están dirigidas para prevenir conflictos en la atención de los pacientes y para mejorar la comunicación con ellos. Debido a la importancia de este tema la CONAMED y el grupo de validación externa coordinado por la Comisión Interinstitucional de Enfermería, emiten estas recomendaciones: 1) Establecer una buena relación enfermera(o)-paciente; 2) Evitar complicaciones en la instalación del catéter; 3) Vigilar la terapia endovenosa para prevenir complicaciones; 4) Retirar el catéter evitando riesgos en la integridad física de los pacientes y 5) Disminuir los factores de riesgo por el personal responsable de la terapia endovenosa

ENGAGING A SPIRIT FROM THE EAST: ASIAN AMERICAN CHRISTIANS AND CIVIC LIFE

Asian Americans are one the fastest growing nonwhite populations and nearly half are Christian. Little is known, however, about the impact of religion on their civic lives beyond volunteerism. This article is a comparative analysis of Asian American Catholic and Protestant civic involvements. In the general population some have argued that the acquisition of civic skills is hindered by Catholic affiliation relative to Protestantism, but it is not know if the same is true for Asian Americans. I explore these issues with data from the Social Capital Benchmark (SCCB) Survey using logistic regression analysis. Results suggest that Protestant Asian Americans are more likely to vote and be interested in politics than Asian American Catholics, but being Protestant is not a significant predictor of community participation. I conclude that religion, particularly with small group participation, is an important resource for all Asian American Christians across broad measures of civic life

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era