Off-pump surgery for the poor ventricle?

Severely decreased ejection-fraction is an established risk-factor for worse outcome after cardiac surgery. We compare outcomes of off-pump coronary artery bypass grafting (OPCAB) and on-pump CABG (ONCABG) in patients with severely compromised EF. From 2004 to 2009, 478 patients with a decreased EF ≤35% underwent myocardial-revascularization. Patients received either OPCAB (n=256) or ONCABG (n=222). Propensity score (PS), including 50 preoperative risk-factors, was used to balance characteristics between groups. PS adjusted logistic regression analysis was performed to assess mortality and major adverse cardiac and cerebrovascular events (MACCE). A composite endpoint for major non-cardiac complications such as respiratory failure, renal failure, rethoracotomy was applied. Complete revascularization (CR) was assumed when the number of distal anastomoses was larger than that of diseased vessels. There was no difference for mortality (2.3 vs. 4.1%; PS-adjusted odds ratio (PS-OR)=1.05; p=0.93) and MACCE (13.7 vs. 17.6%; PS-OR=1.22; p=0.50) including myocardial-infarction (1.4 vs. 4.9%; PS-OR=0.39; p=0.26), low cardiac output (2.3 vs. 4.7%; PS-OR=0.75; p=0.72) and stroke (2.3 vs. 2.7%; PS-OR=0.69; p=0.66). OPCAB patients presented with a trend to less frequent occurrence of the non-cardiac composite (12.1 vs. 22.1%; PS-OR=0.54; p=0.059) including renal dysfunction (PAOR=0.77; 95% CI 0.31-1.9; p=0.57), bleeding (PAOR=0.42; 95% CI 0.14-1.20; p=0.10) and respiratory failure (PAOR=0.39; 95% CI 0.05-3.29; p=0.39). The rate of complete revascularization was similar (92.2 vs. 92.8%; PS-OR=0.75; p=0.50). OPCAB in patients with severely decreased EF is safe and feasible. It may even benefit these patients in regard to non-cardiac complications and does not come at cost of less complete revascularizatio

Quality target negotiation in health care : evidence from the English NHS

We examine how public sector third-party purchasers and hospitals negotiate quality targets when a fixed proportion of hospital revenue is required to be linked to quality. We develop a bargaining model linking the number of quality targets to purchaser and hospital characteristics. Using data extracted from 153 contracts for acute hospital services in England in 2010/11, we find that the number of quality targets is associated with the purchaser’s population health and its budget, the hospital type, whether the purchaser delegated negotiation to an agency, and the quality targets imposed by the supervising regional health authority

Speed-Dependent Cellular Decision Making in Nonequilibrium Genetic Circuits

Despite being governed by the principles of nonequilibrium transitions, gene expression dynamics underlying cell fate decision is poorly understood. In particular, the effect of signaling speed on cellular decision making is still unclear. Here we show that the decision between alternative cell fates, in a structurally symmetric circuit, can be biased depending on the speed at which the system is forced to go through the decision point. The circuit consists of two mutually inhibiting and self-activating genes, forced by two external signals with identical stationary values but different transient times. Under these conditions, slow passage through the decision point leads to a consistently biased decision due to the transient signaling asymmetry, whereas fast passage reduces and eventually eliminates the switch imbalance. The effect is robust to noise and shows that dynamic bifurcations, well known in nonequilibrium physics, are important for the control of genetic circuits

Comparison of trihalomethane formation using chlorine-based disinfectants within a model system; Applications within point-of-use drinking water treatment

© 2019 Clayton, Thorn and Reynolds. Point-of-use (POU) drinking water treatment systems provide solutions for communities where centralized facilities are unavailable. Effective POU systems treat and reduce the number of pathogens in POU water supplies often employing disinfection. Chlorine disinfection results in the formation of disinfection by-products (DBPs), such as trihalomethanes (THMs), through the reaction of chlorine with natural organic matter (NOM) over time. Although THMs are known to be harmful to human health, little is known about their production within POU systems. This study compares the disinfectants; Electrochemically Activated Solutions (ECAS), hypochlorous acid (HOCl), and sodium hypochlorite (NaOCl), with respect to their potential to produce THMs within POU drinking water systems. Headspace solid-phase microextraction (HS-SPME) gas chromatography mass spectrometry (GC-MS) was utilized to quantify THMs in treated water samples containing NOM (Suwannee River humic acid, 4 mg L -1 ). All disinfection treatments were matched to free chlorine concentrations of 1, 3, and 5 mg L -1 , using reaction times of 1, 5, and 10 min. THMs were produced at free chlorine concentrations of 5 mg L -1 and at reaction times of 5 and 10 min for all disinfectants. ECAS or HOCl, resulted in the formation of significantly lower total THM concentrations across all reaction times and free chlorine concentrations, compared to NaOCl. ECAS can be generated at the POU requiring only water, salt and energy for production, and this study demonstrates that its use results in reduced formation of THMs, compared with NaOCl. Further work is required to replicate these findings within scaled-up POU water treatment systems

Exploring the Potential of Laser Capture Microdissection Technology in Integrated Oral BioSciences

Laser capture microdissection (LCM) is a high end research and diagnostic technology that helps in obtaining pure cell populations for the purpose of cell or lesion specific genomic and proteomic analysis. Literature search on the application of LCM in oral tissues was made through PUBMED. There is ample evidence to substantiate the utility of LCM in understanding the underlying molecular mechanism involving an array of oral physiological and pathological processes, including odontogenesis, taste perception, eruptive tooth movement, oral microbes, and cancers of the mouth and jaw tumors. This review is aimed at exploring the potential application of LCM in oral tissues as a high-throughput tool for integrated oral sciences. The indispensable application of LCM in the construction of lesion specific genomic libraries with emphasis on some of the novel molecular markers thus discovered is also highlighted. This article is protected by copyright. All rights reserved

A neuroscientist's guide to lipidomics

Nerve cells mould the lipid fabric of their membranes to ease vesicle fusion, regulate ion fluxes and create specialized microenvironments that contribute to cellular communication. The chemical diversity of membrane lipids controls protein traffic, facilitates recognition between cells and leads to the production of hundreds of molecules that carry information both within and across cells. With so many roles, it is no wonder that lipids make up half of the human brain in dry weight. The objective of neural lipidomics is to understand how these molecules work together; this difficult task will greatly benefit from technical advances that might enable the testing of emerging hypotheses

The influence of laboratory coagulation tests and clotting factor levels on rotation thromboelastometry (ROTEM(R)) during major surgery with hemorrhage

BACKGROUND:The aim of this study was to determine the association between standard laboratory tests, coagulation factor concentrations, and Rotation Thromboelastometry (ROTEM® delta, TEM® International GmbH, Munich, Germany) in patients undergoing major surgery with hemorrhage.METHODS:In 45 patient's fibrinogen, factor VIII, factor XIII, International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), thrombin time, hemoglobin, leukocytes, and platelet count were simultaneously measured intraoperatively with ROTEM (EXTEM, INTEM, FIBTEM, APTEM) measurements. ROTEM parameters were: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and α-angle. Demographic and laboratory data were expressed as mean ± SD and median [range]; nonparametric Spearman rank correlations and multiple linear regressions were performed; P-values ≤0.003 were considered significant.RESULTS:Significant correlations (P ≤ 0.003) were found for CFT, α-angle, and MCF, in EXTEM, INTEM, and APTEM with platelets, INR, and fibrinogen. Factor VIII (18 measurements) showed a strong correlation (r ≥ 0.7 or r ≤ -0.7; all P ≤ 0.003) with MCF, CFT, and α-angle of EXTEM, INTEM, MCF of FIBTEM excluding CT of EXTEM, INTEM, FIBTEM and strong significant correlation for α-angle of APTEM and moderate for CFT and MCF of APTEM. A significant moderate to strong correlation of factor XIII with MCF of EXTEM, INTEM, FIBTEM, and APTEM was found. Hemoglobin was moderately correlated (r = 0.3-0.7 or r = -0.3 to -0.7) with MCF in APTEM (P = 0.003). A moderate to strong correlation of the standard coagulation tests with all ROTEM parameters was found, in particular the CT. The aPTT correlated significantly moderate to strong with CT, CFT, α-angle, and MCF of INTEM. However, multiple linear regressions were not able to show an influence of INR on ROTEM parameters except for APTEM-MCF. A significant impact of the aPTT on INTEM-CT was found. EXTEM, INTEM, and APTEM are significantly influenced by fibrinogen and platelets.CONCLUSIONS:The results confirm the clinical assumption that EXTEM, INTEM, and APTEM are associated with fibrinogen and platelets levels; INTEM-CT significantly to aPTT; and FIBTEM significantly to fibrinogen. Factor VIII showed a significant correlation with all ROTEM parameters except CT of EXTEM, INTEM, FIBTEM, and CFT and MCF of APTEM