Amstrupholm5228

Mitral valve (MV) repair with the MitraClip device has been shown to reduce mitral regurgitation severity and improve clinical outcomes in symptomatic patients at high surgical risk. MitraClip was recently approved in the US for the treatment of functional mitral regurgitation (FMR), which significantly expands the number of patients that can be treated with this device. This study aims to quantify the morphologic changes and evaluate the biomechanical interaction between the MitraClip device and the mitral apparatus of a real patient case with FMR using computational modeling. MitraClip procedures using a central and a lateral clip were simulated in a validated MV-left ventricle finite element (FE) model with severe MR. The patient-specific model integrated detailed geometries of the left ventricle, mitral leaflets and chordae, incorporated age- and gender-matched nonlinear hyperelastic human material properties, and accounted for chordae tethering forces. Central and lateral positioning gave similar biomechanical outcomes resulting in an improved but incomplete MV coaptation. Antero-posterior distance, annulus area, valve opening orifice area, and regurgitant orifice area decreased by up to 26%, 19%, 48% and 63% when compared to the pre-clip model, respectively. Anterior and posterior leaflet peak stresses increased by up to 64% and 62% after clip placement, respectively, and were located at the region of clip grasp. Similarly, anterior and posterior leaflet peak strains increased by up to 20% and 10%, respectively. FE modeling, as used here, can be a powerful tool to examine the complex MitraClip-host biomechanical interaction. BACKGROUND/PURPOSE The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN). METHODS Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap. RESULTS 106 patients with a median age of 4 years (IQR 2-6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)). CONCLUSIONS Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia. LEVEL OF EVIDENCE Level IV. PURPOSE Laparoscopy is commonplace in pediatric surgery. Abdominal access via the umbilicus may present a unique challenge in neonates and young infants predisposing them to complications. We hypothesized that these complications may occur more than described in the literature. METHODS Members of the American Pediatric Surgical Association (APSA) were anonymously surveyed in February of 2018 via REDCap™ regarding technique of umbilical access in infants less than 3 months of age and complications experienced during umbilical access. Approval was obtained from the IRB and the APSA Outcomes and Evidence-based Practice Committee. RESULTS The response rate was 31.3% (329/1050). 62.3% of respondents performed 21 or greater neonatal laparoscopic procedures annually. 34 of 322 respondents reported a direct complication from umbilical access for laparoscopy in this age group (10.6%). Surgeons described 37 specific cases with complications related to umbilical access, with laparoscopic pyloromyotomy making up 47.2% (17/36). CO2 embolism was the most common complication; 15.4% of surgeons reported not knowing about the possibility of CO2 embolism. 41% of surgeons confirm intraabdominal placement of the umbilical trocar prior to insufflation. There was no association between any complication and where the umbilical trocar was placed (above/below/through umbilicus) or placement technique in patients with no umbilical cord stump. There may be an association between complication and where the umbilicus is entered in patients with an umbilical cord stump still in place (p = 0.013). CONCLUSIONS Umbilical access for laparoscopy in neonates and infants less than 3 months of age can present a unique challenge and result in significant complications. All techniques and methods had complications. Surgeons should be aware of these risks and be prepared to manage them emergently if they arise. LEVEL OF EVIDENCE V, expert opinion. The aim of the present study was to isolate, select and characterize endophytic bacteria in rice inhibiting Burkholderia glumae THT as well as to characterize the genetic diversity and virulence factors in strains of B. glumae and Burkholderia gladioli of rice. Rice plants were collected in 4 departments from the northern region of Peru, isolating endophytic bacteria, after tissue sterilization, at 30°C (48h) in Trypticase Soy Agar (TSA), evaluating the antimicrobial activity against B. glumae THT, production of siderophores, resistance of toxoflavine and partial sequencing of the 16S rRNA gene. Furthermore, B. glumae and B. gladioli were isolated in selective medium (pH 4.5) at 41°C/72h. Molecular identification was performed using BOX-PCR and sequencing of the 16S rRNA gene, in addition to the production of extracellular enzymes, motility tests and sensitivity/resistance to bactericides. One hundred and eighty nine (189) endophytic bacteria were isolated, and only 9 strains showed antimicrobial activity against B. glumae THT, highlighting Burkholderia vietnamiensis TUR04-01, B. vietnamiensis TUR04-03 and Bacillus aryabhattai AMH12-02. The strains produced siderophores and at least 55.5% were resistant to toxoflavin. Additionally, 17 strains were grouped into 9 BOX-PCR profiles, where 16 had similarity with B. glumae LMG2196T (100%) and 1 with B. gladioli NBRC 13700T (99.86%). learn more High diversity was found according to geographical origin and virulence factors. In conclusion, strains of the genus Bacillus and Burkholderia are potential biocontrol agents against B. glumae.