Mogensendowney2302

OBJECTIVES Tricuspid annuloplasty is the optimal surgical repair technique for tricuspid regurgitation which improves mortality and morbidity. Ring annuloplasties is the techniques of choice. Here, we evaluate the efficacy and durability of a new method of interrupted pledgeted suture annuloplasty. METHODS Between 2011 and 2018, 39 eligible patients underwent tricuspid valve repair using this novel technique. Indication for repair was a grade of regurgitation at moderate or greater, or an annular diameter >40 mm. Patients were assessed both preoperatively and postoperatively by echocardiogram. Follow-up results were split into the first postoperative echocardiogram and most recent postoperative echocardiogram undertaken. RESULTS There were two in-hospital mortalities and two patients required permanent pacemaker implantation following surgery. At the time of the first postoperative echocardiogram undertaken (median 3 months postoperatively), freedom from moderate-severe regurgitation was 92.3%. At the time of the most recent postoperative echocardiogram undertaken (median 11 months postoperatively); none or mild regurgitation was detected in 24 patients (61.5%), mild-moderate in 11 (28.2%) and moderate-severe in 4 (10.3%) patients. Freedom from moderate-severe regurgitation was 89.7%. Postoperative grade of regurgitation was significantly reduced from preoperative grades (p  less then  0.001). CONCLUSION Initial and midterm results of our technique show a good durability of repair. We have demonstrated recurrence rates of regurgitation equal and superior to current forms of suture annuloplasty published in the literature. This novel method of suture annuloplasty can be considered in the surgical repertoire of tricuspid valve repair techniques.BACKGROUND The gut microbiome has been increasingly acknowledged as playing a pivotal role in human health. Therefore, a number of studies have focused on variables that impact its microbial structure and consequent functionality. A wide range of factors, such as diet, age, sex, life stage, behavior, ethnicity, and diseases have been considered, and strong links were set out. However, some aspects regarding the microbiome determinants are still under-explored. DISCUSSION Recently, Bosman et al. presented evidence that skin exposure to narrowband UVB light modulated the gut microbiome of a specific human cohort. This cohort presented an increase of biodiversity, Firmicutes and Proteobacteria, and a decrease of Bacteroidetes. Based on these findings, we revisited our data on a hunter-gatherer gut microbiome (Yanomami) and identified similarities in the gut microbiome of these two cohorts. Both presented a high abundance of Proteobacteria, which had been observed as a unique feature in the Yanomami gut microbiome, and based on Bosman et al study, could be associated with their natural sunlight exposure. CONCLUSION In this commentary, we would like to point out that the human lifestyle concerning sunlight exposure should be considered as one force modulating the gut microbiome, highlighting, as proposed by Bosman et al, a novel skin-gut axis which is associated with health and disease.INTRODUCTION Vascular access for central venous catheter placement is technically challenging in children. Ultrasound guidance is recommended for pediatric central venous catheter placement, yet many practitioners rely on imprecise anatomic landmark techniques risking procedure failure due to difficulty mastering ultrasound guidance. A novel navigation system provides a visual overlay on real-time ultrasound images to depict needle trajectory and tip location during cannulation. We report the first pediatric study assessing feasibility and preliminary safety of using a computer-assisted needle navigation system to aid in central venous access. METHODS A prospective, institutional review board-approved feasibility study was performed. All participants provided written informed consent. Ten patients (mean age 11.4 years, five males) underwent central venous catheter placement with ultrasound and navigation system guidance. All procedures were performed by interventional radiologists expert in vascular access. Feasibility was measured through binary (yes/no) responses from participating users assessing device usability and feasibility. The number of needle passes and procedure time measures were also recorded. RESULTS Internal jugular veins (seven right sided, three left sided) were cannulated in all patients with no complications. Users confirmed navigation system feasibility in all 10 participants. click here Mean vein diameter and depth was 13.3 × 9.8 ± 3.4 × 2.1 and 7.0 ± 1.7 mm, respectively. Successful cannulation occurred in all patients and required only a single needle pass in 9 of 10 patients. Mean device set-up and vascular access times were 531 ± 228 and 148 ± 235 min, respectively. CONCLUSION This pilot study suggests that it is feasible to use a novel computer-assisted needle navigation system to safely obtain central venous access under ultrasound guidance in pediatric patients.BACKGROUND Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. METHODS Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth  6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis.