Simultaneous enlargement of the pulmonaryannulus and the pulmonary cusp with atransannular patch

AbstractJ Thorac Cardiovasc Surg 2003;125:206-

Quantal description of nucleon exchange in a stochastic mean-field approach

The nucleon exchange mechanism is investigated in central collisions of symmetric heavy ions in the basis of the stochastic mean-field approach. Quantal diffusion coefficients for nucleon exchange are calculated by including non-Markovian effects and shell structure. Variances of fragment mass distributions are calculated in central collisions of Ca-40 + Ca-40, Ca-48 + Ca-48, and N-56 i+ Ni-56 systems

“Hinge” Mitral Valve Repair for Active Valve Endocarditis and Long-term Follow-up Transesophageal Echocardiography Study.

Ciljevi: Liječenje mitralnog zalistka u endokarditisu zalistka izazovna je tema, a rekonstrukcija je poželjnija u odnosu na zamjenu, no često zahtijeva opsežan debridman vegetacije, infi ciranoga tkiva i složenu rekonstrukciju tijekom aktivne faze. Metode: Donosimo prikaz uspješne rekonstrukcije mitralnoga zalistka u pacijenta s aktivnim endokarditisom. Rezultati: Postoperativna ehokardiografi ja nije pokazala regurgitaciju na novoformiranom mitralnom zalistku. Zaključak: Reparacija mitralnoga zalistka perikardijanom zakrpom prvi je izbor liječenja aktivnog endokarditisa, koja je tehnički zahtjevna, no ima zadovoljajuće rezultate. Rekonstrukcija mitralnog zalistka ovom metodom ne samo da podržava otvaranje područja mitralnih komisura, već i potpomaže ponovno uspostavljanje fizilološkoga kretanja mitralnoga zalistka.Aims: Mitral valve treatment in valve endocarditis is currently a challenging issue. Repair is preferred to replacement but it often requires extensive debridement of vegetation and infected tissue as well as complex reconstruction in the active phase. Methods: We report on a successful repair of the mitral valve, as described in the case of active endocarditis. Results: Postoperative echocardiography demonstrated no regurgitation at the newly formed mitral valve. Conclusion: First preference is pericardial repair, a technically difficult procedure but with satisfactory results in mitral repair for active endocarditis. Reconstruction of the mitral commissure with this technique not only supports the opening of the commissural area but also helps regain the physiological motion of the mitral valve

Serum testosterone levels and Colonic Diverticula

Background: Elderly men have a high risk of metabolic syndrome, including an increased risk of obesity. Whether low testosterone is associated with diverticular disease of the colon (DDC) risk independent of metabolic co-factors is not clear. Aim: This study was conducted this study to reveal the possible link between serum testosterone levels and colonic diverticula. Methods: This study was conducted between May 2018 and December 2018, total 208 subjects were enrolled for the study at a university hospital, Turkey. At total, 85 men with DDC were enrolled for the study. DDC was defined by non-contrast CT scan with colonoscopic examination. Control group (123 subjects without DDC; the mean age was 54.5 ±14.5) were selected from otherwise healthy men. Results: Of the 85 men with DDC, the mean age was 60.8 ± 13.5 years. Lower levels of total testosterone were associated with a 25% increased odds of prevalent DDC on adjusted analyses. Importantly, lower levels of total testosterone remained strongly associated with prevalent DDC, even in men with normal glucose levels (p=0.01). Conclusion: Decreasing levels of total testosterone, even within normal range, are independently associated with DDC in elderly age. Androgen deficiency may have an important role in the development of DDC in men and provide a potential novel target for DDC prevention

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation

Aim: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). Patients and methods: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. Results: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. Conclusion: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat