Evolution of antimicrobial prophylaxis in cardiovascular surgery

Objective: To examine the optimal duration of antibiotic prophylaxis in major cardiovascular surgery. Methods: In the past 15 years, four prospective randomized, controlled studies, conducted by the same group of authors, compared seven prophylactic antimicrobial regimens in 2970 patients undergoing major cardiovascular surgery. In 1980/81, a 4-day cefazolin (CFZ) prophylaxis was compared with a 2-day cefuroxime (CFX) administration (n=566). In 1982/83, a 2-day CFX prophylaxis was compared with a two shot ceftriaxone (CRO) prophylaxis (n=512). In 1984/87, a 1-day CFZ prophylaxis was compared with a single shot prophylaxis of CRO (n=883). In 1994/1995, a 4 day combination of amoxicillin (AM) and netilmicin (NET) prophylaxis was compared with a single shot prophylaxis of CFX (n=1009). Results: Total infection rate varied between 4.5 and 5.7%, despite different antimicrobial regimen used and their varying duration. Wound infection rate was 1.1% (range 0.4-2.5%), sepsis rate was 0.8% (range 0.4-1.6%), pneumonia rate 2% (0.7-2.9%), urinary tract infection rate 0.4% (range 0-1.4%), and central venous catheter-related infection rate was 0.4% (0-1%). The 30-day mortality rate was 1.3% (range 0.4-2%). All these differences were not statistically significant. Conclusions: A low infection rate (range 4.5-5.7%) occurred despite changes in duration of various prophylactic antibiotic regimen with cephalosporins of first, second or third generation. As a single shot prophylaxis could nowadays successfully be used in cardiovascular surgery, no postoperative antibiotics should be used, unless an intraoperative or a postoperative infection is documented or in presence of major perioperative complication

Tissue engineering of small caliber vascular grafts

Objective: Previous tissue engineering approaches to create small caliber vascular grafts have been limited by the structural and mechanical immaturity of the constructs. This study uses a novel in vitro pulse duplicator system providing a ‘biomimetic' environment during tissue formation to yield more mature, implantable vascular grafts. Methods: Vascular grafts (I.D. 0.5 cm) were fabricated from novel bioabsorbable polymers (polyglycolic-acid/poly-4-hydroxybutyrate) and sequentially seeded with ovine vascular myofibroblasts and endothelial cells. After 4 days static culture, the grafts (n=24) were grown in vitro in a pulse duplicator system (bioreactor) for 4, 7, 14, 21, and 28 days. Controls (n=24) were grown in static culture conditions. Analysis of the neo-tissue included histology, scanning electron microscopy (SEM), and biochemical assays (DNA for cell content, 5-hydroxyproline for collagen). Mechanical testing was performed measuring the burst pressure and the suture retention strength. Results: Histology showed viable, dense tissue in all samples. SEM demonstrated confluent smooth inner surfaces of the grafts exposed to pulsatile flow after 14 days. Biochemical analysis revealed a continuous increase of cell mass and collagen to 21 days compared to significantly lower values in the static controls. The mechanical properties of the pulsed vascular grafts comprised supra-physiological burst strength and suture retention strength appropriate for surgical implantation. Conclusions: This study demonstrates the feasibility of tissue engineering of viable, surgically implantable small caliber vascular grafts and the important effect of a ‘biomimetic' in vitro environment on tissue maturation and extracellular matrix formatio

Distinct Effects of p19 RNA Silencing Suppressor on Small RNA Mediated Pathways in Plants

RNA silencing is one of the main defense mechanisms employed by plants to fight viruses. In change, viruses have evolved silencing suppressor proteins to neutralize antiviral silencing. Since the endogenous and antiviral functions of RNA silencing pathway rely on common components, it was suggested that viral suppressors interfere with endogenous silencing pathway contributing to viral symptom development. In this work, we aimed to understand the effects of the tombusviral p19 suppressor on endogenous and antiviral silencing during genuine virus infection. We showed that ectopically expressed p19 sequesters endogenous small RNAs (sRNAs) in the absence, but not in the presence of virus infection. Our presented data question the generalized model in which the sequestration of endogenous sRNAs by the viral suppressor contributes to the viral symptom development. We further showed that p19 preferentially binds the perfectly paired ds-viral small interfering RNAs (vsiRNAs) but does not select based on their sequence or the type of the 5’ nucleotide. Finally, co-immunoprecipitation of sRNAs with AGO1 or AGO2 from virus-infected plants revealed that p19 specifically impairs vsiRNA loading into AGO1 but not AGO2. Our findings, coupled with the fact that p19-expressing wild type Cymbidium ringspot virus (CymRSV) overcomes the Nicotiana benthamiana silencing based defense killing the host, suggest that AGO1 is the main effector of antiviral silencing in this host-virus combination

The politics of performance: transnationalism and its limits in former Yugoslav popular music, 1999–2004

This paper examines transnational relations between the Yugoslav successor states from the point of view of popular music, and demonstrates how transnational musical figures (such as Djordje Balaševi?, Mom?ilo Bajagi?-Bajaga and Ceca Ražnatovi?) are interpreted as symbolic reference points in national ethnopolitical discourse in the process of identity construction. Another symbolic function is served by Serbian turbofolk artists, who in Croatia serve as a cultural resource to distance oneself from a musical genre associated by many urban Croats with the ruralization (and Herzegovinization) of Croatian city space. In addition, value judgements associated with both Serbian and Croatian newly composed folk music provide an insight into the transnational negotiation of conflicting identities in the ex-Yugoslav context. Ultimately the paper shows how the ethnonational boundaries established by nationalizing ideologies created separate cultural spaces which themselves have been transnationalized after Yugoslavia's disintegration

Современный взгляд на проблему врожденной цитомегаловирусной инфекции: клинические наблюдения

Тhis work is a continuation of the literature review «The modern view of congenital cytomegalovirus infection» and is devoted to the clinical cases. Particular attention is paid to the severity of congenital cytomegalovirus infection (CCMVI), as well as the its clinical variability, including developmental anomalies. The variety of clinical forms requires a wide range of examinations to identify all this infection manifestations in a newborn child and children in the first months of life, as well as the doctors alertness regarding the timely diagnosis of intrauterine infections based on the existing clinical features. The presented cases demonstrate the CCMVI clinical manifestations: the «classical» generalized manifest form, with a specific clinical, laboratory and instrumental findings, the severe generalized CCMVI with kidney congenital malformation and postnatal development of congenital cataract.Данная работа является продолжением литературного обзора «Современный взгляд на проблему врожденной цитомегаловирусной инфекции» и посвящена разбору клинических случаев. Особое внимание уделено тяжести течения врожденной цитомегаловирусной инфекции (ВЦМВИ), а также клиническому полиморфизму заболевания, в т.ч. с формированием аномалий развитий. Многообразие клинических форм ВЦМВИ требует проведения широкого спектра обследований для выявления всех проявлений данной инфекции у новорожденного ребенка и детей первых месяцев жизни, а также настороженности врачей в отношении своевременной диагностики внутриутробной инфекции на основании имеющейся клинической картины. Представленные случаи демонстрируют особенности клинических вариантов ВЦМВИ: «классической» манифестной формы с генерализованным течением, с характерной клинической картиной и изменениями в лабораторных и инструментальных данных, тяжелого генерализованного течения ВЦМВИ с внутриутробным формированием порока развития почки и постнатальным развитием врожденной катаракты