The Local Bubble and Interstellar Material Near the Sun

The properties of interstellar matter (ISM) at the Sun are regulated by our location with respect to the Local Bubble (LB) void in the ISM. The LB is bounded by associations of massive stars and fossil supernovae that have disrupted natal ISM and driven intermediate velocity ISM into the LB interior void. The Sun is located in such a driven ISM parcel. The Local Fluff has a bulk velocity of 19 km/s in the LSR, and an upwind direction towards the center of the gas and dust ring formed by the Loop I supernova remnant interaction with the LB. When the ram pressure of the LIC is included in the total LIC pressure, and if magnetic thermal and cosmic ray pressures are similar, the LIC appears to be in pressure equilibrium with the local hot bubble plasma.Comment: Proceedings of Symposium on the Composition of Matter, honoring Johannes Geiss on the occasion of his 80th birthday. Space Science Reviews (in press

Current status in decision making to treat acute type A dissection: limited versus extended repair

Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with "downstream problems" support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection

Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy

Objective: To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS). Summary Background Data: LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other. Methods: A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes. Results: A total of 874(49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio):0.39, 95% CI: 0.18-0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27-0.76),wound occurrences (OR: 0.37, 95% CI: 0.11-0.79), and sepsis (OR: 0.52, 95% CI: 0.26-0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS. Conclusions: LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patient's clinical status