OFF-PUMP CORONARY ARTERY BYPASS GRAFTING : LITERATURE REVIEW

Coronary artery bypass grafting (CABG) is a commonly used revascularization technique for coronary artery disease. In addition to traditional on-pump CABG (ONCABG) with cardiopulmonary bypass (CPB), the operation can be performed on a beating heart without CPB and with no need for cardiac arrest, a procedure often called off-pump coronary artery bypass grafting (OPCABG). Extracorporeal circulation, aortic cross-clamping and cardiac arrest in ONCABG predispose the body to inflammatory response, global myocardial damage, coagulation defects and ischemia- reperfusion injury. These are associated with low blood pressure, thrombosis, hyperthermia, tachycardia, leukocytosis and tissue edema which all have detrimental effects on the outcome of the surgery. In OPCABG, these complications were initially thought to be reduced. Especially high-risk patients seem to benefit from OPCABG when compared to conventional ONCABG as it decreases the risk for mortality and morbidity shortly after discharging. On the other hand, the risk of incomplete revascularization and poor graft patency are higher in OPCABG procedures and reoperation is more often needed. Thus, in the long term, the benefit of OPCABG is not as significant. In low- and mid-risk population undergoing OPCABG no significant benefit has been reported. In addition to mortality, the choice between the two is an issue of financial aspect, total hospital stay, risk of complications and the experience of the surgeon. Significant superiority to each other is yet to be proven. The choice between the two methods has still to be made individually for each patient undergoing CABG. The purpose of this review is to search and gather literature and articles related to OPCABG, shortly discuss the role of it in cardiothoracic surgery, consider financial and healthcare aspects, compare short- and long-term outcomes and list some of the major complications of the procedure. Finally, there is a summary of the pros and cons, and the literature-based conclusions. Articles related to OPCABG were searched on PubMed using search keywords myocardial revascularization or myocardial revascularization [Mesh] in combination with OPCAB or OPCABG or off-pump coronary artery bypass or coronary artery bypass, off-pump [Mesh]. Also, some basic information such as explanations of procedures, have been cited from organization websites and published articles related to cardiothoracic surgery

Classification of pomegranate cultivars by multivariate analysis of biochemical constituents of HPLC

Pomegranate fruits are highly diverse and may be divided into geographical groupings based on their characteristics. Genetic research has verified these categories in recent years and further categorized variants into geographic-genetic groupings. This study aimed to assess the biochemical contents of eight varieties of pomegranate fruit seed and the categorization of pomegranate using multivariate statistical analysis. Polyphenolic chemicals are key secondary metabolites in pomegranate, and their presence influences the quality and sensory qualities of the fruit they produce. Fruit extracts from the Faqyan cultivar contained the highest total phenolic content of all studied cultivars. Pomegranate cultivars such as Shaqlawa, Halabja Sour, and Faqyan were shown to have the highest antioxidant activity. Gallic acid, caffeic acid, chlorogenic acid, p-coumaric acid, cinnamic acid, rutin, apigenin, rosmaric acid, and quercetin were the most abundant phytochemical components in the study. According to the results of multivariate analysis, pomegranate cultivars were divided into four major groups. The pomegranate fruit seed is the most abundant source of antioxidants and beneficial phytochemical elements. Finally, the Sidakan Sweet and Shaqlawa cultivars included a significant content polyphenolic compounds

Retrospective observational analysis of a coronary artery bypass grafting surgery patient cohort: Off-pump versus on-pump

ObjectivesTo determine whether surgical technique has an effect on prognosis in coronary artery bypass grafting (CABG).DesignRetrospective observational.SettingSingle center.ParticipantsAll the off-pump (OPCABG) and on-pump (ONCABG) patients at Turku University Central Hospital in 2018.InterventionsNone.Measurements and main resultsAfter propensity score matching, perioperative, 1-year and 3-year mortality did not differ between the groups. The ONCABG patients received more allogenic red blood cells (1.3 vs. 0.6 units, p = 0.020), autologous red blood cells (564 vs. 285 ml, p ConclusionsThe both techniques seem equally safe. However, there may be some benefits to avoiding using a heart-lung machine, such as lower infused fluid volumes. Myocardial damage may also be milder and postoperative hemodynamics more balanced in OPCABG patients, based on lower levels of troponin T and lactate.</p

Modulaarinen ensihoitoreppujärjestelmä

Tämän opinnäytetyön tarkoituksena oli suunnitella ja kehittää ensihoitajien työskentelyä helpottava modulaarisen ensihoitorepuston malli, eli varustelista ensihoitoreppujen sisällöstä, sekä välineiden jaottelusta reppujen sisällä. Repusto suunniteltiin mahdollisimman käyttäjäystävälliseksi. Tällä tarkoitetaan sitä, että välineet jaotellaan kokonaisuuksiin reppujen sisällä helpottamaan yksittäisen ensihoitajan toimintaa sekä tehtävien jakoa useamman ensihoitajan välillä. Tämän opinnäytetyön tiedonhankintamenetelminä on käytetty kirjallisuuskatsausta ja TYKSin ERVA-alueen ensihoidon toimijoille tehtyä kyselyä käytössä olevien ensihoitoreppujen sisällöstä. Kirjallisuuskatsauksen avulla on selvitetty ensihoidon toimintamahdollisuuksia, toimintatapoja ja ensihoidossa tarvittavia välineitä. Ensihoidon toimijoille tehdystä kyselystä saatiin selville TYKSin ERVA-alueella tällä hetkellä käytössä olevat välineet. Kirjallisuuskatsauksesta ja ensihoidon toimijoille tehdystä kyselystä saatua tietoa käytettiin repuston suunnittelussa. Täman opinnäytetyön lopputuotoksena on modulaarisen ensihoitorepuston varustelista, josta käy ilmi reppujen sisältö ja välineiden jaottelu reppujen sisällä. Työssä päädyttiin jakamaan välineet neljään eri reppuun, joista hoito- ja happirepussa hyödynnetään tässä opinnäytetyössä suunniteltua modulaarista rakennetta. Hoito- ja happirepun lisäksi suunnitelmassa käytettiin jo käytössä olevaa lasten reppua ja c-kitiä, joka on Varsinais-Suomen sairaanhoitopiirin alueella käytössä oleva massiivisten verenvuotojen tyrehdyttämistä ja monipotilastilanteita varten rakennettu laukku. Hoito- ja happirepun sisältö ja välineiden jaottelu suunniteltiin sellaiseksi, että välineet on jaoteltu toiminta- ja toimenpitekohtaisiin kokonaisuuksiin, jotka ovat repussa irrallisina osastoina eli moduuleina. Jokaisessa moduulissa on kaikki tarvittavat välineet jonkin tietyn toiminnan tai toimenpiteen suorittamiseen. Tämä helpottaa hoitovälineiden saatavuutta siten, että ensihoitajan ei tarvitse erikseen kerätä tarvitsemiaan välineitä potilaan vierelle. Tällainen moduulirakenne helpottaa myös useamman ensihoitajan yhteistyötä, sillä jokainen voi ottaa suorittamaansa tehtävää tai toimenpidettä vastaavan moduulinThe purpose of this thesis is to develop a model of a functional backpack system for medical emergency care use. The idea is to make a list of the content of each individual backpack, and organize the equipment into different compartments inside each backpack in a way that it would make a job of a single emergency nurse easier but also help with task management between multiple nurses. Data acquisition methods that were used in this thesis were an overview of relevant literature and an inquiry for emergency care providers of TYKS ERVA-region about contents of their backpacks. Possibilities in emergency care, proper practices and required equipment has been studied with the overview of relevant literature. The information about the equipment used in TYKS ERVA-region was acquired with the inquiry that was made as a part of this thesis. The information acquired with the overview of rele-vant literature and the inquiry for emergency care providers of TYKS ERVA-region about the content of their backpacks was used in designing of the backpack system. The final product of this thesis is a list of the content for the modular backpack system that reveals the content of each backpack and the way that equipment is organized inside. Equipment was distributed into four different backpacks, of which response pack and oxygen response pack utilizes the modular structure. In addition an existing childrens response pack and c-kit were used. The c-kit is a pack for catastrophic bleeding and multiple patient situations and it is used in Varsinais-Suomi region. The response- and oxygen response packs consists of modules that are separate from the rest of the pack and can be taken out as a whole. Majority of the equipment is placed in these modules according to the procedure or action that each piece of equipment is related to so there is a module for every action or procedure. This kind of system makes it easier to collect the things one needs because one does not need to collect everything piece by piece. This system is also advantageous when multiple people are treating one patient because everyone can take their own module according to which procedure or action they want to perform