Use of a plant-based polysaccharide hemostat for the treatment of sternal bleeding after median sternotomy

Background: In cardiac surgery profuse or persistent sternal bleeding after sternotomy is routinely controlled with bone wax. However, bone wax should be avoided, especially in high-risk patients for nonunion of the sternum and infections. Purpose of this study was to evaluate an alternative technique to control bleeding after medium sternotomy using a plant based absorbable polysaccharide hemostat. Methods: A consecutive series of 38 patients requiring median sternotomy for coronary artery bypass surgery (21 OPCAB, 17 CABG) had sternal bleeding control with the polysaccharide hemostat, STARSIL (R) HEMOSTAT. This hemostat is a hydrophilic powder, which achieves hemostasis after topical application at the surgical wound site. Initially it dehydrates blood rapidly, thus accelerating aggregation of platelets and blood solids. Thereafter, it forms a gelled adhesive matrix, which serves as a mechanical barrier against further bleeding. The polysaccharide is completely resorbed within 48 to 72 hours. Results: Satisfactory control of sternal bleeding was observed in 37 patients (97%). No product-related complications were observed or any other major adverse events in an observation period of 3 months. Conclusion: Polysaccharide hemostats appear to be safe and effective for bleeding control of the sternum

Use of a plant-based polysaccharide hemostat for the treatment of sternal bleeding after median sternotomy

Background: In cardiac surgery profuse or persistent sternal bleeding after sternotomy is routinely controlled with bone wax. However, bone wax should be avoided, especially in high-risk patients for nonunion of the sternum and infections. Purpose of this study was to evaluate an alternative technique to control bleeding after medium sternotomy using a plant based absorbable polysaccharide hemostat. Methods: A consecutive series of 38 patients requiring median sternotomy for coronary artery bypass surgery (21 OPCAB, 17 CABG) had sternal bleeding control with the polysaccharide hemostat, STARSIL (R) HEMOSTAT. This hemostat is a hydrophilic powder, which achieves hemostasis after topical application at the surgical wound site. Initially it dehydrates blood rapidly, thus accelerating aggregation of platelets and blood solids. Thereafter, it forms a gelled adhesive matrix, which serves as a mechanical barrier against further bleeding. The polysaccharide is completely resorbed within 48 to 72 hours. Results: Satisfactory control of sternal bleeding was observed in 37 patients (97%). No product-related complications were observed or any other major adverse events in an observation period of 3 months. Conclusion: Polysaccharide hemostats appear to be safe and effective for bleeding control of the sternum

Examining implicit metacognition in 3.5-year-old children: an eye-tracking and pupillometric study

The current study examined early signs of implicit metacognitive monitoring in 3.5-year-old children. During a learning phase children had to learn paired associates. In the test phase, children performed a recognition task and choose the correct associate for a given target among four possible answers. Subsequently, children's explicit confidence judgments (CA) and their fixation time allocation at the confidence scale were assessed. Analyses showed that explicit CJs did not differ for remembered compared to non-remembered items. In contrast, children's fixation patterns on the confidence scale were affected by the correctness of their memory, as children looked longer to high confidence ratings when they correctly remembered the associated item. Moreover, analyses of pupil size revealed pupil dilations for correctly remembered, but not incorrectly remembered items. The results converge with recent behavioral findings that reported evidence for implicit metacognitive memory monitoring processes in 3.5-year-old children. The study suggests that implicit metacognitive abilities might precede the development of explicit metacognitive knowledge

12-and 24-Month-Old Infants' Search Behavior Under Informational Uncertainty

Infants register and react to informational uncertainty in the environment. They also form expectations about the probability of future events as well as update the expectation according to changes in the environment. A novel line of research has started to investigate infants' and toddlers' behavior under uncertainty. By combining these research areas, the present research investigated 12- and 24-month-old infants' searching behaviors under varying degree of informational uncertainty. An object was hidden in one of three possible locations and probabilistic information about the hiding location was manipulated across trials. Infants' time delay in search initiation for a hidden object linearly increased across the level of informational uncertainty. Infants' successful searching also varied according to probabilistic information. The findings suggest that infants modulate their behaviors based on probabilistic information. We discuss the possibility that infants' behavioral reaction to the environmental uncertainty constitutes the basis for the development of subjective uncertainty

Diagrams support revision of prior belief in primary-school children

The reluctance of children to revise their prior beliefs is a prominent phenomenon in the reasoning literature. One way to facilitate belief change is offering explanations, and this study examined whether highlighting (counter)evidence with diagrams leads to belief revision to the same extent. Altogether 134 preschoolers and second-graders (5- and 7-year-olds, respectively) were presented with either counterintuitive data or explanations, both refuting a strong commonly held belief concerning the relation between two variables (e.g. eating carrots improves vision). In the explanation condition, we presented children with an explanatory underlying mechanism for the unexpected causal relation (e.g. spinach and carrots contain the same amount of vitamin A, with both improving vision). In the diagram condition, children were presented with empirical data displayed in a bar graph (non-covariation), which also disconfirmed the initial belief. In both age groups and both conditions we found significant numbers of belief revision with high certainty ratings concerning the new belief. Belief change was more pronounced in second-graders, who in addition showed significantly more changes in the diagram condition than in the explanation condition. These findings suggest that the perceptual saliency of (counter)evidence helps children to correctly evaluate hypotheses, which supports changes in their prior belief

Interdisciplinary three-step strategy to treat aortic stenosis and coronary artery disease in a patient with end-stage chronic obstructive pulmonary disease

Background: Valvular aortic stenosis is a common disease in the elderly, often in multimorbid patients. It is often associated with coronary artery disease and peripheral artery disease. In this situation, the risk of conventional open-heart surgery is too high, and other treatment strategies have to be evaluated. Case report: A 79-year-old female patient with severe aortic stenosis, coronary artery disease and end-stage chronic obstructive pulmonary disease suffering from dyspnea at rest and permanently dependent on oxygen was treated in three steps. Firstly, her pulmonary infection was treated with antibiotics for 7 days. Then, the left anterior descending artery was stented (bare-metal stent). In the same session, valvuloplasty of the aortic valve was performed. She was sent to rehabilitation to improve her pulmonary condition and took clopidogrel for 4 weeks. Finally, she underwent transapical aortic valve replacement. She was released to rehabilitation on postoperative day 12. Conclusion: A combination of modern interventional and minimally invasive surgical techniques to treat aortic stenosis and coronary heart disease can be a viable option for multimorbid patients with extremely high risk in conventional open-heart surgery

Creation of ventricular septal defects on the beating heart in a new pig model

Background/ Aims: So far, surgical and interventional therapies for muscular ventricular septal defects ( mVSDs) beyond the moderator band have had their limitations. Thus, alternative therapeutic strategies should be developed. We present a new animal model for the evaluation of such strategies. Methods: In a pig model ( n = 9), anterolateral thoracotomy was performed for exposure of the left ventricle. mVSDs were created under two- and three- dimensional echocardiography with a 7.5- mm sharp punch instrument, which was forwarded via a left ventricular puncture without extracorporeal circulation. Results: Creation of mVSDs was successful in all animals ( n = 9) confirmed by echocardiography, hemodynamic measurements and autopsy. The defects were located in the midmuscular ( n = 4), apical ( n = 1), inlet ( n = 2) and anterior part ( n = 2) of the muscular septum. All animals were hemodynamically stable for further procedures. The diameter and shunt volume of the mVSDs were 4.8 - 7.3 mm ( mean: 5.9 mm) and 12.9 - 41.3% ( mean: 22.1%), respectively. Autopsy confirmed in all animals the creation of a substantial defect. Conclusion: The described new technique for creation of an mVSD on the beating heart in a pig model is suitable for the evaluation of new therapeutic strategies for mVSD closure. Copyright (C) 2008 S. Karger AG, Basel

How Does Children’s Theory of Mind Become Explicit? A Review of Longitudinal Findings

How does theory of mind become explicit? In this article, we provide a brief overview of theoretical accounts and then review longitudinal findings on the development of theory of mind from infancy to the preschool years. Long‐term predictive relations among conceptually related measures of implicit and explicit theory‐of‐mind reasoning support a conceptual continuity view of the transition from an implicit to an explicit understanding of the mind. We discuss alternative, minimalist accounts of infant psychological reasoning (e.g., two‐systems models, submentalizing theory) and their implications for the development of theory of mind in light of the evidence. Longitudinal findings further support a developmental enrichment view of joint attention as a foundation of theory of mind and early social interaction as a powerful mechanism in the development of this ability. Finally, we highlight the importance of longitudinal data for our understanding of conceptual development from infancy to the preschool years

Developmental Trajectories in Diagnostic Reasoning: Understanding Data Are Confounded Develops Independently of Choosing Informative Interventions to Resolve Confounded Data

Two facets of diagnostic reasoning related to scientific thinking are recognizing the difference between confounded and unconfounded evidence and selecting appropriate interventions that could provide learners the evidence necessary to make an appropriate causal conclusion (i.e., the control-of-variables strategy). The present study investigates both these abilities in 3- to 6-year-old children (N = 57). We found both competence and developmental progress in the capacity to recognize that evidence is confounded. Similarly, children performed above chance in some tasks testing for the selection of a controlled test of a hypothesis. However, these capacities were unrelated, suggesting that preschoolers' nascent understanding of the control-of-variables strategy may not be driven by a metacognitive understanding that confounded evidence does not support a unique causal conclusion, and requires further investigation