The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization

Objective: To determine the relative risk of sternal dehiscence in patients undergoing bilateral internal thoracic artery harvesting and to assess whether and to what extent the technique of artery skeletonization might reduce this risk. Methods: Prospectively collected data on patients undergoing coronary artery bypass operations with at least a single internal thoracic artery were reviewed. The last 450 patients receiving bilateral internal thoracic artery grafts were compared with 450 patients who received a single internal thoracic artery during the same period. The left internal thoracic artery was always harvested in a pedicled fashion. Among patients receiving a bilateral internal thoracic artery, both arteries were harvested in a pedicled fashion in 300 cases, whereas both internal thoracic arteries were skeletonized in the remaining 150 cases. Results: Compared with a single internal thoracic artery, harvesting both internal thoracic arteries either in a skeletonized or in a pedicled fashion increased the chance of deep (1.1% vs 3.3% vs 4.7%; P =. 01) or superficial (4.8% vs 7.8% vs 12%; P =. 002) sternal infection. However, the technique of artery harvesting (odds ratio, 4.1; 95% confidence interval, 1.4-12.1); the presence of peripheral arteriopathy (odds ratio, 3.1; 95% confidence interval, 1.2-8.5), and resternotomy for bleeding (odds ratio, 8.2; 95% confidence interval, 2.0-33.6) were the only independent predictors for deep sternal infection, whereas the technique of artery harvesting (odds ratio, 3.0; 95% confidence interval, 1.6-5.4), female sex (odds ratio, 2.2; 95% confidence interval, 1.2-4.2), and diabetes (odds ratio, 1.7; 95% confidence interval, 1.0-2.9) were the only independent predictors of superficial sternal infection. In diabetic patients, there was no difference in the incidence of deep sternal infection among patients receiving a single internal thoracic artery or double skeletonized internal thoracic arteries (P =. 4). Conclusions: Bilateral internal thoracic artery harvesting carries a higher risk of sternal infection than harvesting a single internal thoracic artery. Skeletonization of both internal thoracic arteries significantly decreases this risk. A strategy of bilateral thoracic artery grafting can also be offered to patients at high risk for wound infection. Copyright © 2005 by The American Association for Thoracic Surgery

A review and meta-analysis of mitigation measures for nitrous oxide emissions from crop residues

Crop residues are of crucial importance to maintain or even increase soil carbon stocks and fertility, and thereby to address the global challenge of climate change mitigation. However, crop residues can also potentially stimulate emissions of the greenhouse gas nitrous oxide (N$_{2}$O) from soils. A better understanding of how to mitigate N$_{2}$O emissions due to crop residue management while promoting positive effects on soil carbon is needed to reconcile the opposing effects of crop residues on the greenhouse gas balance of agroecosystems. Here, we combine a literature review and a meta-analysis to identify and assess measures for mitigating N$_{2}$O emissions due to crop residue application to agricultural fields. Our study shows that crop residue removal, shallow incorporation, incorporation of residues with C:N ratio > 30 and avoiding incorporation of residues from crops terminated at an immature physiological stage, are measures leading to significantly lower N$_{2}$O emissions. Other practices such as incorporation timing and interactions with fertilisers are less conclusive. Several of the evaluated N$_{2}$O mitigation measures implied negative side-effects on yield, soil organic carbon storage, nitrate leaching and/or ammonia volatilization. We identified additional strategies with potential to reduce crop residue N$_{2}$O emissions without strong negative side-effects, which require further research. These are: a) treatment of crop residues before field application, e.g., conversion of residues into biochar or anaerobic digestate, b) co-application with nitrification inhibitors or N-immobilizing materials such as compost with a high C:N ratio, paper waste or sawdust, and c) use of residues obtained from crop mixtures. Our study provides a scientific basis to be developed over the coming years on how to increase the sustainability of agroecosystems though adequate crop residue management

Challenges of accounting nitrous oxide emissions from agricultural crop residues

Crop residues are important inputs of carbon (C) and nitrogen (N) to soils and thus directly and indirectly affect nitrous oxide (N$_2$O) emissions. As the current inventory methodology considers N inputs by crop residues as the sole determining factor for N$_2$O emissions, it fails to consider other underlying factors and processes. There is compelling evidence that emissions vary greatly between residues with different biochemical and physical characteristics, with the concentrations of mineralizable N and decomposable C in the residue biomass both enhancing the soil N$_2$O production potential. High concentrations of these components are associated with immature residues (e.g., cover crops, grass, legumes, and vegetables) as opposed to mature residues (e.g., straw). A more accurate estimation of the short-term (months) effects of the crop residues on N$_2$O could involve distinguishing mature and immature crop residues with distinctly different emission factors. The medium-term (years) and long-term (decades) effects relate to the effects of residue management on soil N fertility and soil physical and chemical properties, considering that these are affected by local climatic and soil conditions as well as land use and management. More targeted mitigation efforts for N$_2$O emissions, after addition of crop residues to the soil, are urgently needed and require an improved methodology for emission accounting. This work needs to be underpinned by research to (1) develop and validate N$_2$O emission factors for mature and immature crop residues, (2) assess emissions from belowground residues of terminated crops, (3) improve activity data on management of different residue types, in particular immature residues, and (4) evaluate long-term effects of residue addition on N$_2$O emissions

Challenges of accounting nitrous oxide emissions from agricultural crop residues

Crop residues are important inputs of carbon (C) and nitrogen (N) to soils and thus directly and indirectly affect nitrous oxide (N2O) emissions. As the current inventory methodology considers N inputs by crop residues as the sole determining factor for N2O emissions, it fails to consider other underlying factors and processes. There is compelling evidence that emissions vary greatly between residues with different biochemical and physical characteristics, with the concentrations of mineralizable N and decomposable C in the residue biomass both enhancing the soil N2O production potential. High concentrations of these components are associated with immature residues (e.g., cover crops, grass, legumes, and vegetables) as opposed to mature residues (e.g., straw). A more accurate estimation of the short-term (months) effects of the crop residues on N2O could involve distinguishing mature and immature crop residues with distinctly different emission factors. The medium-term (years) and long-term (decades) effects relate to the effects of residue management on soil N fertility and soil physical and chemical properties, considering that these are affected by local climatic and soil conditions as well as land use and management. More targeted mitigation efforts for N2O emissions, after addition of crop residues to the soil, are urgently needed and require an improved methodology for emission accounting. This work needs to be underpinned by research to (1) develop and validate N2O emission factors for mature and immature crop residues, (2) assess emissions from belowground residues of terminated crops, (3) improve activity data on management of different residue types, in particular immature residues, and (4) evaluate long-term effects of residue addition on N2O emissions

Pleosporales

One hundred and five generic types of Pleosporales are described and illustrated. A brief introduction and detailed history with short notes on morphology, molecular phylogeny as well as a general conclusion of each genus are provided. For those genera where the type or a representative specimen is unavailable, a brief note is given. Altogether 174 genera of Pleosporales are treated. Phaeotrichaceae as well as Kriegeriella, Zeuctomorpha and Muroia are excluded from Pleosporales. Based on the multigene phylogenetic analysis, the suborder Massarineae is emended to accommodate five families, viz. Lentitheciaceae, Massarinaceae, Montagnulaceae, Morosphaeriaceae and Trematosphaeriaceae

How to play a MOOC: Practices and simulation

Massive Open Online Courses are important online study resources. They aim at providing online education to an increasingly large and heterogeneous audience: school pupils, university students or professionals who intend to acquire or develop their skill to better respond to market needs. The growing number of learners (more than 100 million globally at the moment, https://www.classcentral.com/report/mooc-stats-2019/) and courses (over 11 thousand, ibidem) reveals new and unprecedented scenarios in lifelong learning paths. Offering educational products to such an audience requires producers \u2013 not only private individuals but also public entities \u2013 to evaluate new teaching methods and methodologies for distance learning, in order to encourage participation and reduce their dropping out. Using gamification within an online course seems to contribute to the growth of users\u2019 participation rate, as well as to increase the course completion rate. In this work, the authors will show the interactive solutions that two Italian universities, the University of Naples Federico II \u2013 with its Federica Web Learning branch \u2013 and the University of Padua set up for their MOOC-based courses

The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization.

OBJECTIVE: To determine the relative risk of sternal dehiscence in patients undergoing bilateral internal thoracic artery harvesting and to assess whether and to what extent the technique of artery skeletonization might reduce this risk. METHODS: Prospectively collected data on patients undergoing coronary artery bypass operations with at least a single internal thoracic artery were reviewed. The last 450 patients receiving bilateral internal thoracic artery grafts were compared with 450 patients who received a single internal thoracic artery during the same period. The left internal thoracic artery was always harvested in a pedicled fashion. Among patients receiving a bilateral internal thoracic artery, both arteries were harvested in a pedicled fashion in 300 cases, whereas both internal thoracic arteries were skeletonized in the remaining 150 cases. RESULTS: Compared with a single internal thoracic artery, harvesting both internal thoracic arteries either in a skeletonized or in a pedicled fashion increased the chance of deep (1.1% vs 3.3% vs 4.7%; P = .01) or superficial (4.8% vs 7.8% vs 12%; P = .002) sternal infection. However, the technique of artery harvesting (odds ratio, 4.1; 95% confidence interval, 1.4-12.1); the presence of peripheral arteriopathy (odds ratio, 3.1; 95% confidence interval, 1.2-8.5), and resternotomy for bleeding (odds ratio, 8.2; 95% confidence interval, 2.0-33.6) were the only independent predictors for deep sternal infection, whereas the technique of artery harvesting (odds ratio, 3.0; 95% confidence interval, 1.6-5.4), female sex (odds ratio, 2.2; 95% confidence interval, 1.2-4.2), and diabetes (odds ratio, 1.7; 95% confidence interval, 1.0-2.9) were the only independent predictors of superficial sternal infection. In diabetic patients, there was no difference in the incidence of deep sternal infection among patients receiving a single internal thoracic artery or double skeletonized internal thoracic arteries ( P = .4). CONCLUSIONS: Bilateral internal thoracic artery harvesting carries a higher risk of sternal infection than harvesting a single internal thoracic artery. Skeletonization of both internal thoracic arteries significantly decreases this risk. A strategy of bilateral thoracic artery grafting can also be offered to patients at high risk for wound infection