A primer for the student joining the general thoracic surgery service tomorrow: Primer 2 of 7.

This medical student primer discusses general thoracic surgery, which involves treating pathologies involving all structures in the thorax except the heart, thoracic aorta, great vessels, and spine

How I perform totally endoscopic robotic mitral valve repair.

A sixty-two-year-old male presented with significant symptoms related to severe mitral regurgitation with posterior leaflet flail and prolapse on transesophageal echocardiogram (TEE). Preoperative computed tomography (CT) angiography showed normal caliber thoracoabdominal aorta and patent access vessels. The patient underwent totally endoscopic robotic mitral valve repair (rMVr) with left atrial CryoMAZE procedure

Robotically Assisted Mitral Valve Repair—Port-Only Totally Endoscopic Approach

Robotic mitral valve repair (MVR) is an emerging option to treat degenerative valve disease. Compared to open thoracotomy, robotic mitral valve surgery has been shown to afford decreased postoperative length of stay with comparable rates of mortality and morbidity. Among the variety of techniques for robotic MVR, the totally endoscopic approach remains the least invasive method to date. In this report, we describe our technique for totally endoscopic robotically-assisted MVR. In particular, we seek to highlight the use of several unique techniques in MVR. Percutaneous cannulation with use of the endoballoon is employed for cardiopulmonary bypass (CPB), thus avoiding traditional aortic cross-clamping. Moreover, intercostal nerve cryoanesthesia is performed from T3–T9 to reduce post-operative pain and aid in reducing opioid management. Barbed, nonabsorbable sutures are used throughout the procedure (for left atrial appendage closure, mitral valve annuloplasty band placement, left atrial closure, pericardial re-approximation), eliminating the need for knot-tying at several steps. We also detail the installation of two sets of neochords for mitral regurgitation and the fastening of the mitral annuloplasty band. Finally, we would like to highlight the small size of each port used in the case (eight millimeters maximum diameter). Taken together, these features of the robotic platform make it notable for its minimally invasive approach to MVR

Irrigation Zone Delineation and Management with a Field-Scale Variable Rate Irrigation System in Winter Wheat

Understanding spatial and temporal dynamics of soil water within fields is critical for effective variable rate irrigation (VRI) management. The objectives of this study were to develop VRI zones, manage irrigation rates within VRI zones, and examine temporal differences in soil volumetric water content (VWC) from irrigation events via soil sensors across zones. Five irrigation zones were delineated after two years (2016 and 2017) of yield and evapotranspiration (ET) data collection. Soil sensors were placed within each zone to give real time data of VWC values and assist in irrigation decisions within a 23 ha field of winter wheat (Triticum aestivum ‘UI Magic’) near Grace, Idaho, USA (2019). Cumulative irrigation rates among zones ranged from 236 to 298 mm. Although a statistical comparison could not be made, the irrigation rates were 0.6 to 21% less than an estimated uniform grower standard practice (GSP) irrigation approach. Based on soil sensor data, crop water stress was avoided with VRI management in all but Zone 3. Thus, this simple approach to VRI zone delineation and VWC monitoring has the potential to reduce irrigation, such as this study, on average by 12% and should be evaluated in other site-years to assess its viability

Improving quality of care through early discharge on postoperative day one or two following robotic cardiac surgery

Cardiac surgery is traditionally associated with a postoperative length of stay (LOS) of at least one week.1-2. The reduced invasiveness of the robotic platform facilitates discharge on postoperative day one (POD1) or two (POD2), thus minimizing cost and risk of hospital-associated complications. We sought to evaluate the characteristics of patients who underwent POD1 or POD2 discharge after robotic cardiac surgery at Jefferson

MAGIC observation of the GRB 080430 afterglow

Context. Gamma-ray bursts are cosmological sources emitting radiation from the gamma-rays to the radio band. Substantial observational efforts have been devoted to the study of gamma-ray bursts during the prompt phase, i.e. the initial burst of high-energy radiation, and during the long-lasting afterglows. In spite of many successes in interpreting these phenomena, there are still several open key questions about the fundamental emission processes, their energetics and the environment. Aims. Independently of specific gamma-ray burst theoretical recipes, spectra in the GeV/TeV range are predicted to be remarkably simple, being satisfactorily modeled with power-laws, and therefore offer a very valuable tool to probe the extragalactic background light distribution. Furthermore, the simple detection of a component at very-high energies, i.e. at similar to 100GeV, would solve the ambiguity about the importance of various possible emission processes, which provide barely distinguishable scenarios at lower energies. Methods. We used the results of the MAGIC telescope observation of the moderate resdhift (z similar to 0.76) GRB 080430 at energies above about 80 GeV, to evaluate the perspective for late-afterglow observations with ground based GeV/TeV telescopes. Results. We obtained an upper limit of F(95% CL) = 5.5 x 10(-11) erg cm(-2) s(-1) for the very-high energy emission of GRB 080430, which cannot set further constraints on the theoretical scenarios proposed for this object also due to the difficulties in modeling the low-energy afterglow. Nonetheless, our observations show that Cherenkov telescopes have already reached the required sensitivity to detect the GeV/TeV emission of GRBs at moderate redshift (z less than or similar to 0.8), provided the observations are carried out at early times, close to the onset of their afterglow phase