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data set suggests that approximately only 1 in 5 patients with POAF after isolated CABG got prescribed OAC.Adult cor triatriatum sinister associated with severe mitral regurgitation is extremely rare. As these obstructive cor triatriatum feature hemodynamics that mimic mitral stenosis, a pressure load is theoretically generated only on the left atrial proximal chamber, and therefore the left ventricle is less likely to suffer volume loading. Here, we report a surgical case with such rare hemodynamics. A 22-year-old man with obstructive cor triatriatum and severe mitral regurgitation received an anomalous membrane excision and mitral annuloplasty. An abnormal membrane with an orifice 7 mm in size was completely resected while a grossly dilated mitral annulus was repaired via annuloplasty ring. Mitral regurgitation was controlled well, and the postoperative course was uneventful. Even with obstructive cor triatriatum, severe mitral annular dilatation and subsequent left ventricular dilatation may occur, causing the progressive heart failure encountered in this case.

Reducing the leg wound morbidity is crucial for the patients undergoing coronary artery bypass grafting (CABG) with great saphenous vein (SV) grafts harvested by no-touch (NT) technique. This study was to summarize the experience of skin bridging technique for reducing wound morbidity and the influence of it on one-year bypass graft patency.

According to skin bridging or not, harvesting times, graft length, number of bleeding branches, postoperative subjective perception assessment scale (ASEPSIS) scores and one-year patency rate were analyzed.

From June 2018 to February 2019, 60 patients underwent CABG with SV grafts either with open-incision NT or skin bridging NT (30 in each group). There were no significant differences in age (71.4 ± 5.1 years vs. 68.9 ± 5.5 years) or graft length (23.3 ± 1.1 cm vs. 23.9 ± 1.3 cm) between the two groups. The bridging/NT group had a significantly longer harvest time (38.5 ± 4.9 min vs. 18.5 ± 2.6 min; P < 0.001) and a significantly greater number of bleeding branches (1.9 ± 1.2 vs. 0.8 ± 0.8; P < 0.001) than the open NT group. The open NT group had a significantly higher ASEPSIS score (23.8 ± 2.0 vs. 15.7 ± 2.6; P < 0.001). There was no significant difference in patency rate at one-year follow-up.

Obtaining the SV by the combined NT/discontinuous skin bridging technique is a satisfactory method for patients who underwent CABG. This method has important clinical significance in reducing wound morbidity in the harvest of NT grafts.

Obtaining the SV by the combined NT/discontinuous skin bridging technique is a satisfactory method for patients who underwent CABG. This method has important clinical significance in reducing wound morbidity in the harvest of NT grafts.Many medical students figure that their fourth year of medical school should be a time primarily focused on residency interviews and resting up for residency. While the interview part is necessary, the concept that one should be resting during that year is a myth. In fact, nothing could be further from the truth. Your top priority should be to prepare yourself to hit the ground running as a great surgical intern.To further the understanding of how to build or reduce synchrony in a work team, we examined two principles for defining the optimal condition to produce or limit synchrony (a) the empath-driver ratio (relative strength of the stronger influencer compared to the receptive strength of any member in the group), and (b) the balance between autocorrelated autonomic arousal (degree to which members' signals are independent of other group members) and the degree of influence that transfers from each group member to other group members. In study 1, we employed a series of computational simulations designed to manipulate the four variables. The results indicated that there is a four-way balance between driver strength, empath strength, autocorrelational and transfer effects among team members. The relationship between the synchronization coefficient and the empath-driver ratio was moderated by whether the group adopted a network structure for group problem solving or command-and-control. In study 2 we analyzed autonomic arousal (electrodermal response) in four teams of five participants playing a first-person shooter computer game. The correlation between the synchronization coefficient and the empath-driver ratio was 0.280 (p less then .001) based on 64 pairs of observations. The relationship was moderated by both the network structure and the statistical model that one adopted to analyze dyadic relationships within the group. The implications of these relationships for a growing theory of team synchrony are discussed.The present study explores the role of convergent and divergent thinking in learning sciences from the nonlinear dynamical system (NDS) perspective. The participants (N=375) were fifth and sixth graders, aged 11-12, who were taking an introductory course in science. Students' understanding of physical phenomena, such as melting, boiling and evaporation was investigated as a function of four neo-Piagetian constructs via the difference-equation cusp catastrophe model. The nonlinear models where logical thinking acted as the asymmetry factor and field dependence/ independence, convergent thinking and divergent thinking acted as bifurcation factors, were superior, explaining 43-44% of the variance, whereas their linear alternatives explained 0-18%. Empirical evidence regarding the role of the above neo-Piagetian constructs at these early ages is reported for the first time and contributes to theory development within the NDS framework. Further, discussion about the significance of the findings is provided.Gaze behavior represents a complex phenomenon in social inter-action. We focus here on dyadic face-to-face interaction during naturally occurring verbal exchanges, where shared attention can be operationalized by joint gazes and eye contact. A multi-step methodology for the analysis of eye synchrony is presented, exemplified by a single case. The dynamics of face-to-face interaction allows estimating the degree of interlocutors' synchrony. While there is growing evidence for interpersonal synchrony of various behavioral and physiological signals, eye synchrony has not yet been studied outside the laboratory. The method presented is based on time series of gaze behavior acquired by mobile eye tracking devices. We applied windowed cross-correlations to the data and used surrogate testing to attain effect sizes even for single interactions (Surrogate Synchrony, SUSY). SUSY thus integrates nomo-thetic with idiographic research goals The nomothetic interest is to test hypotheses that gaze behavior may be generally synchronized and linked with psychological variables. The idiographic aspect is that effect sizes can be determined even in single-case studies owing to the surrogate analyses, which supports qualitative research. Results of the exemplary dataset suggested that proof-of-concept of this approach was attained. We describe what prerequisites are needed of a setting and technical setup for use in future studies of psychotherapy, counseling, negotiations, or work-related interactions.We discuss a computational model that describes stabilization of percept choices under intermittent viewing of an ambiguous visual stimulus at long stimulus intervals. Let T_off and T_on be the time that the stimulus is off and on, respectively. The behavior was studied by direct numerical simulation in a grid of (T_off, T_on) values in a 2007 paper of Noest, van Ee, Nijs, and van Wezel. They found that both alternating and repetitive sequences of percepts can appear stably, sometimes even for the same values of T_off and T_on. Longer T_off, however, always leads to a situation where, after transients, only repetitive sequences of percepts exist. We incorporate T_off and T_on explicitly as bifurcation parameters of an extended mathematical model of the perceptual choices. We elucidate the bifurcations of periodic orbits responsible for switching between alternating and repetitive sequences. We show that the stability borders of the alternating and repeating sequences in the (T_off, T_on) -parameter plane consist of curves of limit point and period-doubling bifurcations of periodic orbits. The stability regions overlap, resulting in a wedge with bistability of both sequences. We conclude by comparing our modeling results with the experimental results obtained by Noest, van Ee, Nijs, and van Wezel.Since its inception the science of physiology, like many other non-physical disciplines, has been guided in its development by the mechanical models of physics. That strategy has proven to be extraordinarily successful, even surviving the introduction of fractals into the modeling strategy. That is until quite recently. The true complexity of physiologic networks has been revealed with the development and implementation of ever more sensitive sensors and mathematically sophisticated data processing techniques. These developments have led to a divergence of the modeling strategies appropriate for the physical sciences from those for the life sciences. Therefore, we review how far the fractal concept has taken us into the non-mechanical interpretation of physiology. What emerges in this brief review of fractal physiology is the increasing importance of criticality, the cooperative nature of networks in physiologic behavior, and the importance of the fractional calculus in characterizing the dynamics of living systems. We draw some further inferences from the review and speculate as to what research directions might be most productive for continuing future success.

MUTYH-associated polyposis is a rare disorder resulting from mutations involved in DNA mismatch repair. This results in an increased susceptibility to colonic adenomatosis and other cancers. Studies have examined the resulting frequency of extracolonic manifestations; however, these typically occur alone, concurrently, or temporally separate from an already diagnosed colorectal cancer in individuals with a biallelic mutation.

Reported here is a case of five distinct primary neoplasms presenting simultaneously in a patient monoallelic for an MYH mutation. These neoplasms included squamous cell carcinoma of the vulva, rectal adenocarcinoma, synchronous anal adenocarcinoma, papillary thyroid carcinoma, and ovarian serous psammocarcinoma. Throughout her course, she underwent multiple surgical procedures, neoadjuvant chemoradiation, with further adjuvant therapy, and treatment ongoing. Due to her unique presentation, she underwent genetic testing that demonstrated she was monoallelic for an MYH mutation.

The patient had a positive response to her treatment and surgical procedures with ongoing adjuvant therapy. She will continue to undergo further genetic testing, and testing for her children is being considered. This case demonstrates a unique presentation associated with a monoallelic MYH mutation that is not described in the current literature and warrants further investigation.

The patient had a positive response to her treatment and surgical procedures with ongoing adjuvant therapy. She will continue to undergo further genetic testing, and testing for her children is being considered. This case demonstrates a unique presentation associated with a monoallelic MYH mutation that is not described in the current literature and warrants further investigation.