Meltonjohnston1391

BACKGROUND Extracorporeal membrane oxygenation (ECMO) is rapidly becoming a mainstream technology for lung or heart/lung support. Current ECMO devices mostly consist of a power-driven centrifugal pump and a dedicated oxygenator. We studied the safety and efficacy of a novel, fully pneumatically-driven ECMO device, which could be used in both veno-venous or veno-arterial mode in an animal model. METHODS Six healthy, awake sheep were treated with the Mobybox ECMO device (Hemovent, Aachen, Germany) over a 7-day period in a veno-venous mode. Gas exchange, coagulation parameters and safety were assessed. RESULTS Using a blood flow rate of 2 L/min and a low sweep gas flow rate of 0.3 L/min, the PCO2 ranged from 38-44 mmHg pre oxygenator and dropped to 32-36 mmHg post oxygenator, whereas the PaO2 post oxygenator increased to 600 mmHg. Higher levels of sweep gas flow resulted in cessation of spontaneous breathing in some animals, consistent with high-efficiency carbon dioxide removal; thus, the sweep gas flow rate was maintained at a low level. Platelets dropped from 177±53/μL to 107±28/μL on day two, while returning to baseline by day seven (180±51/μL). Plasma-free hemoglobin remained low (2-9 mg/dl), whereas fibrinogen slightly increased, and then remained stable throughout the period. Neither the pump nor the oxygenator showed any visible clotting after 7 days. CONCLUSIONS The pneumatically-driven ECMO device provides excellent safety and physiologic efficacy in a 7-day sheep experiment without visible clotting, hemolysis, or sustained reductions in fibrinogen or platelets. Simultaneous repair of congenital tracheal and cardiovascular lesions remains challenging in small patients. We describe two infants weighing less than 3 kg who underwent successful tracheoplasty with concomitant correction of complex heart anomalies. In both operations, cardiopulmonary bypass was switched to extracorporeal membrane oxygenation after cardiac repair to optimize hemostatic function with transfusion and maintain activated clotting time at 200-240s. Slide tracheoplasty was performed in a bloodless field, which prevented intraoperative hemorrhage from running down the divided lower trachea into the lung and causing airway obstruction. Both patients were weaned from extracorporeal support during surgery and extubated within 9 days. BACKGROUND Co-morbid long segment congenital tracheal stenosis (LSCTS) and congenital cardiovascular (CVS) abnormalities in children pose significant challenges in regard to repairing them simultaneously or in stages. The aim of this study is to explore if this combination of abnormalities needs a staged approach for surgical repairs. METHODS All children who underwent both tracheal and cardiac surgeries at a tertiary hospital from 1995 to 2018 were analyzed retrospectively for mortality, ventilation days, post-operative intensive care unit (ICU) days, mediastinitis and unplanned reoperation by dividing them into simultaneous repairs (Group 1), staged repairs within the same admission (Group 2) and staged repairs during different admissions (Group 3). RESULTS Of 110 patients included in the study (Group 1=74, Group 2=10 & Group 3=26), there was no significant difference in mortality (p=0.85), median ventilation days (p=0.99), median ICU days (p=0.23), unplanned airway reoperation (p=0.36) and unplanned cardiac reoperation (p=0.77). There was a significant difference in the rate of mediastinitis (Group 1=3%, Group 2=10% and Group 3=19%, p=0.02). There was no significant difference in 5-year survival (Group 1=86.2%, Group 2=77.8% and Group 3=85.1%, p=0.86). A higher STAT category was identified to be a risk factor for mortality in multivariate Cox regression analysis (relative risk=5.45). CONCLUSIONS Combined tracheal and cardiac abnormalities need a stratified approach to facilitate better clinical outcomes. While the trajectory of care is often based on the clinical presentation, establishing a management protocol will be helpful for which setting an international database will be useful. BACKGROUND The oncologic efficacy of segmentectomy is controversial. We compared long- term survival in clinical stage IA (T1N0) patients undergoing lobectomy and segmentectomy in Medicare patients in the STS database. METHODS The Society of Thoracic Surgeons General Thoracic Surgery Database (STS- GTSD) was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n=1654) or lobectomy (n=12,632) for clinical stage IA disease from 2002-15. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs. RESULTS In Cox modeling, segmentectomy is associated with survival similar to lobectomy in the entire cohort [HR 1.04, 95%CI (0.89,1.20), P=0.64] and in the matched subcohort. CUDC-907 chemical structure A subanalysis restricted to the 2009-15 population (n=11,811), when T1a tumors were specified and PET scan results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival [HR 1.00, 95% CI (0.87,1.16)]. Subanalysis of the pathologic N0 patients demonstrated the same results. link2 CONCLUSIONS Lobectomy and segmentectomy for early stage lung cancer are equally effective treatments with similar survival. STS surgeons appear to be selecting patients appropriately for sublobar procedures. A male infant with Kabuki syndrome was diagnosed with trivial congenital mitral regurgitation at birth. At the age of 2 years and 9 months, the regurgitation worsened from mild to severe; thus, expedited surgical treatment was pursued. The primary operative finding was severe dysplastic two-leaflet disease. After completing chordal replacement as a conventional repair procedure, more-than-moderate central regurgitation caused by establishing a shallow coaptation between the anterior and posterior leaflets persisted. We report a successful case of mitral valve repair involving the novel option of interannular bridge for valvuloplasty to address congenital mitral regurgitation. BACKGROUND Data on blood utilization in proximal aortic surgery is limited. We sought to establish quality benchmarks in the pattern of transfusion during elective aortic root replacement. METHODS The STS Adult Cardiac Surgery Database was queried to identify all patients who underwent primary elective aortic root replacement between July 2014 and June 2017. Multivariable negative binomial regressions were utilized to determine whether perioperative transfusion was associated with demographic and/or procedural factors. Multivariable logistic regression analysis was performed for clinical outcomes. RESULTS Of 5559 patients analyzed, 38.95% (n = 2165) received no blood products. Patients who had a valve-sparing root replacement were less likely to be transfused than those who received composite roots (bioprosthetic or mechanical valves) or homografts. Thirty-day mortality for all patients was 2.57% (n = 143). Transfusion was associated with an increased risk of death at 30 days (odds ratio OR 1.833, p = 0.0124), more frequent reoperation for bleeding (OR 1.766, p = 0.0006), prolonged ventilation (OR 1.935, p less then 0.0001), a longer postoperative hospital stay (OR 1.056, p less then 0.0001), and a higher incidence of new dialysis-dependent renal failure (OR 2.088, p = 0.0031). link3 There was no correlation between institutional case volume and transfusion practice. CONCLUSIONS Elective aortic root replacement can be performed with acceptable requirements for blood products. Composite root replacement has a greater likelihood of transfusion than does a valve-sparing procedure. Transfusion is independently associated with more complications after elective aortic root surgery, including 30-day mortality. Testosterone regulates the male reproductive system and acts directly or indirectly on nearly all systems during fetal, pubertal and adult life. Testosterone homeostasis depends on its synthesis and degradation. The major biotransformation reactions are hydroxylation by different cytochrome P450 (CYP) isoforms. There are no described methods to determine the profile of testosterone-hydroxylated metabolites in human urine. The aim of this study was to develop an analytical method to determine testosterone-hydroxylated metabolites in human urine using UPLC-MS. Seven testosterone-hydroxylated metabolites, androstenedione, and testosterone, were identified by comparison of their tret and positive electrospray ionization (ESI+) data, with those of analytical standards. The method developed is sensitive, specific, repeatable, and precise. Limits of detection and quantitation for all compounds ranged from 1.360 to 13.054 ng/ml and 4.234-39.679 ng/ml, respectively. The percentages of recovery were between 81.2 and 128.8%. The applicability of the analytical method was confirmed by analysis of urine samples obtained from two groups of healthy men (25-30 and 50-75 years old). All analytes were identified with slightly different metabolites profiles in both groups. In conclusion, the UPLC-MS method developed here was validated for the analysis of testosterone-hydroxylated metabolites in human urine. A novel fast room temperature cloud point extraction (RT-CPE) procedure for preconcentration and spectrophotometric determination of phosphate based on the heteropoly blue formation was developed. The proposed method includes the formation of yellow molybdoantymonatophosphoric heteropoly complex, its extraction into Triton X-100 micellar phase obtained at room temperature and reduction of heteropoly complex by ascorbic acid solution in ethanol and absorbance measurement of heteropoly blue at 790 nm. Under optimal conditions (1% (v/v) of Triton X-100 and 0.05 M of ammonium benzoate for initiating of RT-CPE; 0.13 M ethanolic solution of ascorbic acid for reduction of heteropoly complex and dilution of surfactant rich phase), the calibration graph is linear in the range of phosphate concentrations of 1.58-63 μg L-1. The proposed RT-CPE procedure has been successfully applied to preconcentration phosphates and its spectrophotometric determination in water samples. N-glycosylation plays an essential role in regulating protein folding and function in eukaryotic cells. Sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH) has proven useful as a data independent acquisition (DIA) MS method for analysis of glycoproteins and their glycan modifications. By separating the entire m/z range into consecutive isolation windows, DIA-MS allows comprehensive MS data acquisition and high-sensitivity detection of molecules of interest. Variable width DIA windows allow optimal analyte measurement, as peptide ions are not evenly distributed across the full m/z range. However, the m/z distribution of glycopeptides is different to that of unmodified peptides because of their large glycan structures. Here, we improved the performance of DIA glycoproteomics by using variable width windows optimized for glycopeptides. This method allocates narrow windows at m/z ranges rich in glycopeptides, improving analytical specificity and performance. We show that related glycoforms must fall in separate windows to allow accurate glycopeptide measurement.