bluuebunny/crossref_metadata_2025 huggingface dataset:
Aristotelian scholia in the Serbian Church-Slavonic translation of Gregory Palamas’ “Apodictic treatises on the procession of the holy spirit”
Authors: Knezevic Mikonja
Published: December 2024

The Serbian Church-Slavonic translation of Gregory Palamas? ?Apodictic
Treatises on the Procession of the Holy Spirit? was made around 1360. The
autograph of this translation, preserved in Codex 88 of the monastery
Decani, contains significant number of scholia, which help us additionally
to follow the process of translating and commenting of Palamas? basic text.
In this paper I will focuss on two of those scholia which reveal the
philosophical thread of Palamas? (theological) argumentation - first of all,
the Aristotelian one. After the basic information on the significance of the
Serbian Church-Slavonic translation of Palamas? ?Apodictic Treatises? is
provided, these scholia are given in the original and translation into
Modern Serbian, being also accompanied by our comments and clarifications.
Imagining the monstrous other: An introduction to the research on the medicalized undead
Authors: Mandic Marina
Published: December 2024

Monsters are liminal subjects, whose ambivalent position challenges
culturally established distinctions between the normal and abnormal, the
ordered and disordered, and the healthy and unhealthy. They blur the lines
between self and other, the familiar and the unfamiliar, and the ?us? versus
?them.? The indeterminacy of these categories embodies itself in what we
term ?human monsters? ? Individuals transformed into monsters after death.
These undead figures display the terrifying consequences of their
transformation, primarily through their uncanny appearance and identity
characteristics. This paper serves as an introduction to various
perspectives on monstrous Others and the medicalization of the undead
(mainly zombies). It aims to formulate initial hypotheses for researching
the impacts of disease, death, and monstrous transformation, including
bodily, identity, and cognitive characteristics that determine and redefine
our understanding of monstrosity and humanity.
Combining environmental DNA data and taxonomic surveys provides an unprecedented understanding of lichen diversity and accelerates the discovery of new species
Authors: Vondrák Jan , Svoboda Stanislav , Malíček Jiří , Šoun Jaroslav , Košnar Jiří , Svensson Måns , Timdal Einar , Machač Jiří , Palice Zdeněk
Published: December 2024

Sequencing of environmental DNA is increasingly used to estimate biodiversity at various taxonomic and spatial levels. However, most such studies tend to deal with abstract numbers not linked to species names, which hampers evaluation and downstream use of the results. In our survey of epiphytic lichens in the Czech Republic, we managed to link sequences from environmental DNA with species names, using an existing reference database of DNA barcodes. On 1-ha sites in various types of central-European forests, we were able to compare DNA data from environmental samples with (i) results of a parallel taxonomic survey and (ii) species abundance data on a country-wide scale. In the environmental DNA data, we detected a large number of species strongly under-recorded in taxonomic surveys and in previous distributional data from the Czech Republic. Most of these species are either very small or poorly known microlichens notoriously overlooked by taxonomists. Some are rare species with specific ecological requirements, but many are relatively abundant. Numerous species apparently new to science were detected, of which 12 species and two genera are newly described here: Allarthothelium endochlorum, Atrodiscus fagicola (new genus), Bacidina omnicola, Biatorella ligni-putridi, Cryptodiscus neglectus, Gyalidea gabretae, Karstenia dryina, Micarea lobarica, Monilibrachium splendens (new genus), Psoroglaena neglecta, Toniniopsis pruinose and Xylopsora diffissa. In the descriptions, eDNA data are, for the first time in lichenology, utilized for characterizing ecology and distribution of the new species. In addition, 43 species detected by eDNA are new to the Czech Republic (23 of them confirmed by the parallel taxonomic survey). Absconditella amabilis and Chaenotheca nitidula are new to Europe.
Distribution of Water Quality Parameters Using Equation Multiple Linear Regression
Authors: Wahyuningsih Sri , Andriyani Idah , Soekarno Siswoyo , Khoirulloh Deffa
Published: December 2024

Mayang River in Jember Regency has a strategic role in fulfilling people's lives and is a source of water for 79 irrigation areas with a total area of 16,471 hectares. Community use of the Mayang River has the potential to provide input of organic material from waste which can reduce river water quality. The aim of this research is to analyze the spatial distribution of water quality parameters, namely TSS, TDS, pH, DO and BOD. This research uses multiple linear regression techniques to determine the value of the distribution or spatial distribution of Mayang River pollution, as well as identifying water quality variables that are correlated in each region. The research results show that water quality parameters that have a strong correlation are pH (r = 0.74), DO (r = 0.72) and TSS (r = 0.65), moderate correlation with BOD parameters (r = 0.48) and low correlation with BOD parameters. TDS parameters (r = 0.25). Based on the analysis results, it is known that water quality parameters are correlated with different activities in each region. The results of this research can be used as a strategy for monitoring water quality in the Mayang River to control the impact of human activities in the surrounding area. Keywords: Multiple Linear Regression, Spatial Distribution, Water Quality.
Mutfaklarda Kullanılan Mobilyaların Kullanıcı Memnuniyeti Üzerine Bir Araştırma
Authors: Çil Muhammet , Gedik Tarık
Published: December 2024

Yapay çevrenin bir parçası olan konut, insanoğlunun temel ihtiyaçlarını karşılaması amacıyla birçok çalışmaya konu olmuştur. Konut içerisinde yer alan mutfak da bu çalışmalar içerisinde en çok araştırılan ve değişiklik yapılan bir mekândır. Yapılan bu çalışmayla, ev hanımlarının mutfaklarının ergonomik açıdan değerlendirilmesi ve mutfaklarıyla ilgili memnuniyet düzeylerinin belirlenmesi amaçlanmıştır. Bu amaç doğrultusunda, İstanbul ili Beşiktaş ilçesi Dikilitaş semtinde ikamet eden ve Halk Eğitim Merkezinde çeşitli kurslara katılan 60 kadın katılımcıya ulaşılmıştır. Elde edilen sonuçlara göre, katılımcılarca kullanılan mutfakların %62’sinin 10 m2 ve daha büyük alana sahip olduğu ve katılımcılar mutfaklarının alansal yeterliliğinden %54,5 oranında memnun olduklarını ifade etmişlerdir. Katılımcıların en fazla I (düz) tipi mutfağa sahip oldukları ve bu mutfaklarda da %60 oranında modern mutfak tarzını benimsedikleri belirlenmiştir. Katılımcıların %61,4’ü günde ortalama olarak üç saatten fazla mutfakta zaman geçirdiklerini belirtmişlerdir. Yapılan istatistiksel değerlendirmeler sonucunda iyi bir mutfak tasarımı için gerekli olan faktörler beş ana başlıkta ortaya çıkarılmıştır. Bunlar; mutfak tezgâhının kullanışlılığı, antropometrik uyum, estetiklik, mutfak dolabının kullanışlılığı ve ekonomikliktir. Katılımcılar mutfak dolaplarını yüksek düzeyde kullanışlı bulsalar da estetik açıdan mutfak dolaplarını beğenmemektedirler. Katılımcıların mutfak tezgâhının yüksekliğinden yüksek oranda memnun oldukları tespit edilmiştir. Mutfak tasarımının kullanıcılara ergonomik açıdan uygun olmasının önemi göz ardı edilemeyecek bir konudur. Bu yüzden bu konu ile ilgili yapılan tüm araştırmalar doğrultusunda ortaya konulan öneriler göz önünde tutularak mutfak tasarımları geliştirilmeli ve değişimlerin takip edilmesini sağlayacak güncel çalışmalar yapılmalıdır.
Implementasi Optimasi Topologi dalam Perencanaan Komponen Penunjang Manipulator pada Robot Penanganan Benda Berbahaya
Authors: Annanto Gilar Pandu , Pratama Fandy Indra , Nugroho Agung , Putri Farika Tono
Published: December 2024

Penelitian ini bertujuan untuk mengembangkan dan mengoptimalkan desain pada salah satu komponen penunjang pada manipulator robot kendali jarak jauh untuk penanganan objek berbahaya. Dalam penelitian ini, digunakan perangkat lunak CAD (Computer-Aided Design) dan CAE (Computer-Aided Engineering) untuk merancang dan menganalisis geometri bracket servo. Geometri awal dianalisis menggunakan material Poly-Lactic Acid (PLA) dengan mempertimbangkan kondisi batas berupa torsi maksimum yang dapat dikeluarkan oleh servo yang digunakan. Hasil analisis awal menunjukkan tegangan maksimal sebesar 3,936 MPa dan deformasi maksimal sebesar 0,062 mm. Proses optimasi topologi dilakukan untuk mereduksi area yang tidak mengalami tegangan besar, menghasilkan geometri baru dengan volume dan massa yang lebih rendah. Setelah optimasi, volume geometri berkurang sebesar 17,5% dan massa berkurang dari 97,213 g menjadi 81,776 g. Analisis lanjutan menunjukkan tegangan maksimal sebesar 3,881 MPa dan deformasi maksimal sebesar 0,09 mm, dengan penurunan tegangan maksimal sebesar 2% dan peningkatan deformasi sebesar 45%. Meskipun terjadi peningkatan deformasi, geometri baru tetap aman dengan faktor keamanan sebesar 18.
“Joint Recruitment of Four Universities in Macao” is based on the multi-source theory
Authors: Ieong Fat Fai , CHEANG TakHong
Published: December 2024

This study applies the multiple streams theory. It will further analyze the internal factors of the confluence of multiple sources, in order to explain why the “Joint Recruitment of Four Universities in Macao” policy has become the agenda of the Macao government. The entrance examination requirements from Macau universities are various. They increase local students’ pressure and consume their energy, thus serving as the source of the Problem Stream. The Policy Stream is represented by the Macau government’s intention to reduce students’ educational burden through establishing a unified assessment system. The Political Stream includes the Macau government’s commitment to improving the Macau education system, such as strengthening the multi-assessment system and the “The Fundamental Law of Non-tertiary Education System”. The convergence of these three sources has opened a policy window for the “Joint Recruitment of Four Universities in Macao” system, leading to a new student evaluation system. This policy not only addresses Macau’s social challenges and improves education governance while also highlighting the city’s educational diversity endeavors. Additionally, the strategies for implementing the “Four-University Joint Examination” policy include reducing the number of exams for students, implementing multi-education and multi-enrollment in higher education institutions, analyzing and improving the examination system based on educational big data, and understanding the basic elements and integration paths of big data in higher education. The Macau government can adjust major settings and enrollment quota allocation in the future, draw in more students from the Community of Portuguese-Speaking Countries and the “Belt and Road” regions, and integrate the joint admission method into the Greater Bay Area education cooperation in order to meet the needs of the growing Macao education industry.
The impact of investment in the manufacturing and processing industry on economic growth in Vietnam
Authors: Khang Nguyen The
Published: December 2024

This study considers the relationship between investment in the manufacturing and processing industries and economic growth in Vietnam. This study applies an autoregressive distributed lag (ARDL) model to reassess the long- and short-term relationships between industrial investment and economic growth from 1998 to 2023. It has been found that in both the long and short term, investments in this sector have a positive and significant effect on economic growth. The results further show that labor negatively affects growth in the long run, but is favorable in the short run. The verdict for the role of exports is that more evidence is required before any conclusive analysis can be conducted. Reinvestment in the manufacturing and processing industries for further economic growth is evident in the foregoing analysis. On the other hand, this research provides insight into the optimization of the utilization of resources and future sustainability by the government.
TRANSCATHETER MITRAL VALVE REPAIR IN A SURGICAL UNIT: UPDATED RESULTS
Authors: Russo M. , Cammardella A. G. , Ciuffreda A. , Pergolini A. , Sbaraglia F. , Ranocchi F.
Published: December 2024

Background and Aim:

Transcatheter edge-to-edge repair (TEER) has been introduced as a valuable tool for the treatment of high-risk patients affected by mitral valve regurgitation. We present the results of a dedicated surgical team.

Methods:

From November 2020 to August 2024, Fifty-four patients (median age 81 y.o, range 39-90, 55% male, 1 urgent procedure) with severe mitral valve regurgitation underwent TEER. A dedicated structural valve team has been established. All cases have been approved by the local weekly heart team according risk profile or specific contra-indication to conventional surgery. Data were collected prospectively.

Results:

Twenty-two patients (40%) were affected by functional MR of whom two cases were performed as bridge to heart transplantation. In the remaining cases, P2 prolapse was present in (50%) patients, leaflet retraction and commissural disease in 10%. Procedural success (MR<2) was achieved in 92% of cases. In the elective cases, 30-day survival was 98%. Kaplan Meier Freedom from cardiac death was 85±5% and 77±3% at 12 and 24 months. Freedom from MR recurrence (>2+) at 12 months was 90±3%%. At mean follow up of 11±2 months, functional status significantly improved (NYHA class 3±0.8 vs 1.25±0.25).

Conclusions:

Surgeon’s headed transcatheter mitral valve repair program is a feasible concept that can should expanded in dedicated centers. TEER is a safe and reproducible procedure that represents a useful tool in armamentarium of the contemporary cardiac surgeon. Late results have to be balanced with the preoperative patient’s characteristics
MID-TERM OUTCOMES OF MODIFIED BENTALL USING A SELF- ASSEMBLED BIOLOGICAL COMPOSITE GRAFT WITH INSPIRIS RESILIA VALVE
Authors: Fiore A. , D’Alonzo M. , Leprince P. , Achouh P. , Poitier B. , Demondion P. , Folliguet T.
Published: December 2024

Background:

The modified Bentall procedure is a standard surgical approach for aortic root pathologies, including aneurysms, endocarditis with abscess, and aortic dissections. Despite requiring aortic valve replacement, this procedure yields excellent results. Prosthesis selection should be individualized based on patient characteristics, contraindications to anticoagulation, and patient preference. This study aims to assess early and mid-term outcomes of the modified Bentall procedure using a 4th generation pericardial valve.

Methods:

This multicentric observational prospective registry includes patients from three French centers, enrolled from 2019 to 2023. Inclusion criteria involved all consecutive patients undergoing modified Bentall with the Inspiris Resilia aortic valve bioprosthesis. Patients under 18 were excluded. Of the 1208 patients, 151 met the inclusion criteria (mean age: 61.9 ± 9.8 years, 11.3% female, mean EuroSCORE II: 5.3%).

Results:

In-hospital mortality was 2.6%. At 30 days, mortality was 6.0% for aortic aneurysm, 16.4% for aortic dissection, and 20% for endocarditis. Severe patient-prosthesis mismatch was observed in 1.7% at discharge. Four-year follow-up (median 25 months) showed 2.6% endocarditis, 0% severe structural deterioration, 12.6% overall mortality, and 9.3% cardiac- related death.

Conclusions:

The modified Bentall with a biological composite graft is safe and effective for various aortic root pathologies. Incorporating the 4th generation Inspiris Resilia valve into the Valsalva graft does not complicate the procedure. Aortic root aneurysm patients show excellent early and mid-term outcomes, with a 90.2±5.5% survival rate at 4-year. Longer follow-up is needed to evaluate long-term outcomes.
LONG-TERM IMPACT OF CHRONIC KIDNEY DISEASE ON CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING
Authors: Gastino E. , Garatti A. , Scarpanti M. , Buttiglione G. , D’Ovidio M. , Canziani A. , Daprati A. , de Vincentiis C. , Parolari A. , Menicanti L.
Published: December 2024

Background and Aim:

Chronic kidney disease (CKD) is one of the major comorbidities in patients undergoing coronary artery bypass grafting (CABG). Its effect on adverse events after surgery is well established, however, the impact of CKD even at early stages on long-term outcomes after CABG is unclear.

Methods:

We analyze 4493 patients who underwent isolated CABG between 2005 and 2018. They were divided into five classes according to the KDIGO definition based on eGFR. Record linkage with the NHIS codes allowed identification of long-term outcomes.

Results:

There was a clear trend of worsening risk profile in patients from Class 1 to 4, while Class 5 showed a reverse pattern, most likely reflecting a prevalent primary end-stage renal disease (ESRD). There was no significant difference in intra-operative variables from classes 1 to 5. Short-term postoperative outcomes progressively declined from class 1 to 4, with class 5 presenting less overall complications. On the other hand, patients in class 5 had a significantly higher 30-day mortality. At 5 and 10 years follow-up, we observed an overall survival decreasing from Class 1 to 3 (p<0.001). Accordingly, Classes 4 and 5 showed dramatically worse long-term survival (49%-21% and 41%-18% respectively, p=n.s.). Classes 4 and 5 did not show a statistically significant difference in the rate of MACCE when compared to Classes 1-3.

Conclusion:

In our experience, The dramatic decrease in survival for ESRD patients can be attributed to the natural history the disease. Further studies are warranted to better clarify the topic.
A HUGE IMPELLA-RELATED AORTIC THROMBUS IN A D-LVAD PATIENT SUCCESSFULLY TREATED WITH THE INARI FLOWTRIEVER SYSTEM
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Galanti G. A. , Aloi V. , Sandoval A. , Gallone G. , Di Scalzi A. , Trompeo A. C. , Boffini M. , Rinaldi M.
Published: December 2024

Micro-axial flow pumps (mAFPs), eventually associated with ECLS, have emerged as a valid option to treat cardiogenic shock as a bridge to durable LVAD (d-LVAD) therapy.

We describe the case of a 55-year-old man with acute myocardial infarction-related cardiogenic shock (AMI-CS) who was bridged from ECMELLA to d-LVAD. He subsequently developed early right heart failure and required a temporary right ventricular assist device (t-RVAD). Four days later the RV function recovered, and TEE showed an incidental huge floating thrombus in the descending aorta. Despite anticoagulation, the thrombus remained stable. However, fibrinolysis wasn’t a suitable option due to high bleeding risk of pre-existing cerebral lesions thus, after a multidisciplinary team discussion (cardiac surgeons, anesthesiologists, interventional radiologists), we decided for mechanical thrombectomy using the FlowTriever System (Inari Medical, Irvine, CA).
EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT AS TREATMENT FOR CARDIOGENIC SHOCK: TREATMENT STRATEGIES AND ANALYSIS OF RISK FACTORS
Authors: Loforte A. , Parrella B. , Spitaleri A. , Aloi V. , Abbà P. , De Laurentis A. , Cura Stura E. , Costamagna A. , Zanierato M. , Trompeo A. C. , La Torre M. W. , Boffini M. , Rinaldi M.
Published: December 2024

Background and Aim:

RotaFlow and CardioHelp (Getinge), used in central (c-) or peripheral (p-) veno-arterial (VA) extra-corporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for patients with cardiogenic shock (CS).

Methods:

Between 2005 and 2024, 359 consecutive adult patients were supported on VA ECMO, at our institution (239 men; age 55.1±14.2 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of post-cardiotomy (n=134) and primary donor graft failure (n=39); post-acute myocardial infarction CS (n=79); acute myocarditis (n=34); and acute decompensation on chronic heart failure (n=27).

Results:

A p-ECMO setting was established in 241(67.13%) patients while c-ECMO in 118 (32.9%). Overall mean support time was 5.1±4.8 days. 187(52,1%) patients died on ECMO. Overall success rate was 48%, in terms of survival on ECMO (n = 241), weaning from mechanical support (n=132;54.8%), bridge to ventricular assist device (n=13;5.47%), and heart transplantation (n=26;10.7%). Stepwise Cox regression multivariate identified age, blood lactate level and SAPS II score value as significant predictors of mortality on ECMO (P=0.040, hazard ratio [HR]=2.01; 95% confidence interval [CI]=1.00–3.03; P<0.0001, HR=3.63; 95% CI=1.03-5.12 and P=0.017, HR=2.4; 95% CI=1.00–3.04, respectively), while “awake-on- ECMO condition” was a significant predictor of survival (P=0.023, HR=0.48; 95% CI=0.26- 1.90). c-ECMO population had significantly higher rate of rethoracotomy for bleeding (50%). Significant differences at 30-days were seen by comparing Kaplan-Meier survival estimates of left ventricular (LV) venting vs. no-LV venting cohorts (p=0.0073).

Conclusions:

A proper weight of pre-operative patients’ characteristics and a proactive LV venting set may contribute to improve the outcomes on ECMO support.
SAFETY AND EFFICACY OF TRANSCATHETER AORTIC VALVE REPLACEMENT FOR NATIVE PURE AORTIC VALVE REGURGITATION: SINGLE–CENTER EXPERIENCE
Authors: Cavalli G. G. , Vallabini A. , Braccio M. , Palladino M. , Gallo N. , Arcudi G. , Alemanni R. , Spatuzza P. , Di Marco L. , Leone A. , Greco F. , Pacini D. , Cassese M.
Published: December 2024

Background:

Considering unique procedural challenges posed by native pure aortic regurgitation (NPAR), our aim was to evaluate off–label transcatheter treatment with new generation devices.

Materials and Methods:

We retrospectively enrolled 65 consecutive patients, the largest single-centre cohort to the best of our knowledge, who underwent TAVR for NPAR between 2017 and 2024, because deemed ineligible for surgery. Mean logistic and Euroscore II were 18,01±11,42% and 5,66±5,71%, though they did not accurately reflect surgical ineligibility: 8 patients (12,3%) had active cancer and 5(7,7%) end–stage liver failure. Patients with valve calcifications or stenosis were excluded. Primary endpoints were technical and device success.

Results:

We adopted local anesthesia in 60 patients (92,3%), reducing ICU admission and stay (26,2% and 1,86±6,32days). Most frequently implanted prostheses were Evolut R/Pro 34(41,5%), Sapien 3/Ultra 29(26,2%) and Accurate Neo M (10,8%). Approximately half of the population was shortly supported(23,53±24,13 minutes) with percutaneous fem–fem VA- ECMO, reducing hemodynamic instability. However, no increase in neither minor nor major vascular complication was observed (p=0,11 and p=0,27). One intraprocedural death was recorded (1,5%). Although 30–day mortality was 7,7%, primary outcomes were significantly better in the second half of the population (p=0,023 and p=0,026), reflecting the role of a standardized approach and surgeons’ higher expertise. Only 1 moderate paravalvular leaks was detected at 1–month follow–up.

Conclusions:

TAVR is still considered an off–label approach for NPAR because of increased stroke volume and absence of annular and leaflets calcification. Nonetheless a standardized approach, with the aid of brief VA ECMO support for complex cases, should be considered a safe and valid option for inoperable patients.
AGE EFFECT ON EARLY AND LATE VARC-3 OUTCOMES IN REDO AORTIC VALVE REPLACEMENT: A MULTICENTER STUDY
Authors: Pradegan N. , Lena T. , Garufi L. , Addonizio M. , Bifulco O. , Longinotti L. , Andreis M. , Di Eusanio M. , Mangino D. , De Paulis R. , Gerosa G.
Published: December 2024

Background and Aim:

Redo aortic valve replacement (re-AVR) is usually associated to increased operative mortality compared to primary aortic valve surgery. Limited data are available regarding the effect of age on outcomes after re-AVR. We aimed to analyze clinical outcomes after re-AVR with a focus on age effect.

Materials and Methods:

All adults who underwent re-AVR between January 2015-December 2022 at 4 Centers were retrospectively analyzed. Primary endpoints were VARC-3 periprocedural and >30-day death. Univariable Cox analysis was employed to assess the effect of age on survival outcome.

Results:

215 patients (male 136 -63%-, median age 69, IQR 59-75) were included. Previous biological prostheses were used in 164 cases (76%). Median EuroSCORE II was 4.8% (IQR 3.0-8.1%). Causes of reintervention were: structural valve deterioration=100 (47%), endocarditis=87 (40%), paravalvular leak=14 (6%). Combined surgery (aortic valve + other) occurred in 99 patients (46%). Urgent operations occurred in 43 patients (20%). A biological prosthesis was implanted in 159 cases (74%). VARC-3 periprocedural death occurred in 22 cases (10%). Age did not affect VARC-3 periprocedural death (HR 0.87, CI 95% 0.53-1.42, p=0.42). At follow-up (median=4 years, IQR 2-5), overall survival was 81% (CI 75-86) and 77%(CI 71-84) at 3 and 5 years, respectively. Age at re-AVR>70-year was a risk factor for VARC-3 death>30 days (HR 2.64, CI 95% 1.04-6.71, p=0.0012).

Conclusions:

Re-AVR is associated to increased mortality. Age does not affect VARC-3 periprocedural death, but patients ≥70 years are at significantly increased risk of mortality>30 days. Age might become a selection criterium for reAVR.
INFLUENCE OF SURGICAL EXPERTISE ON REPAIR OF ACUTE TYPE A AORTIC DISSECTION. A PROPENSITY SCORE MATCHED ANALYSIS.
Authors: Piani D. , Sponga S. , Lechiancole A. , Gliozzi G. , Copetti S. , Vendramin I.
Published: December 2024

Objective:

We aimed to verify whether in patients with acute type A aortic dissection the results of aortic repair are significantly influenced by surgeon expertise.

Methods:

199 patients with acute type A aortic dissection were divided in two groups: those operated by expert (n=138) and those by not-expert aortic surgeons (n=61) all being members of the aortic team. Early outcomes in both groups were evaluated and compared. A propensity score matching analysis was applied to obtain two similar populations.

Results:

The clinical presentation was more compromised in patients operated by expert than by not-expert surgeons: 36% vs 16% being hemodynamically instable (p=0.005) and 22% vs 5% having focal neurological damage (p=0.003). Intraoperative setting was similar among the two groups, with axillary artery cannulation being almost routinely used. Expert surgeons performed more frequently arch surgery (40% vs 26%, p=0.06). Operative times were also similar with median cardiopulmonary bypass time of 203 minutes for expert and 201 minutes for not-expert surgeons, respectively (p=0.88). Median in-hospital stay was shorter for patients operated by not-expert that by expert surgeons (10 and 17 days, p=0.04). After propensity score matching, mortality was still not significantly different between expert and not-expert surgeons (5% versus 12%, p=0.43).

Conclusions:

Outcomes of patients with acute type A aortic dissection were satisfactory even when surgery was performed by not-expert surgeons included in an aortic team organization.
SHORT-TERM OUTCOMES OF HEART TRANSPLANT FROM DONATION AFTER CIRCULATORY DEATH VERSUS DONATION AFTER BRAIN DEATH.
Authors: Maffei I. , Marani F. , Mazzeo G. , Raimondi Lucchetti M. , Marogna L. , Francica A. , Galeone A. , San Biagio L. , Onorati F. , Luciani G. B.
Published: December 2024

Background and Aim:

This study aims to compare the short-term outcomes of heart transplant (HT) from donors who died from brain death (DBD) versus those who died from circulatory death (DCD).

Methods:

This study includes adult patients who underwent HT from January 2023 to July 2024. Recipient characteristics, operative times, postoperative data, and length of hospital stay were compared.

Results:

A total of 34 patients were included (n=5 DCD, n=29 DBD). The two groups had similar median age (DBD 59 vs DCD 57; p=0.4). The cold ischemia time (DBD 170 min, DCD 84 min; p=0.002), cardiopulmonary bypass (DBD 156 min, DCD 171 min; p 0.6), cross-clamping (DBD 73 min, DCD 75 min; p=0.66), and total surgery time (DBD 390 min, DCD 318 min; p=0.05) were compared. No differences in median postoperative Vasoactive-Inotropic Score (p=0.94), duration of invasive ventilation (p=0.18), postoperative dialysis (p=0.22), major infections (p=0.19), and cellular rejection (>/=2) at the first biopsy post-transplant (DBD 34%, DCD 20%; p=0.47) were found. Finally, no differences were noted concerning ICU stay or overall hospital stay (p=0.2 and 0.3, respectively).

Conclusions:

Our results indicate that the ischemia time and the overall duration of the procedure were lower in the HT from DCD compared to DBD (potentially due to heart retrieval from DCD more often done in the same institution of the recipients, and the lower number of reintervention). First results indicate no differences in short term outcome between HT from DCD and DBD.
RISK FACTORS IN POSTOPERATIVE DELIRIUM IN CARDIAC SURGERY: MULTICENTER OBSERVATIONAL STUDY
Authors: Mercuri C. , Mele M. , Pastorelli M. , Peyer M. T. , Zaghis L. , Ceccotti F. , Elegante J. , Bosco V. , Comentale G. , Cozato G. , Doldo P. , Froio A. , Matroroberto P. , Mazzoccoli E. , Mipatrini A. , Nisticò T. A. , Perrone M. , Sbalchiero E. , Scettro M. , Zampieri E. , Pucciarelli G. , Reitano B. , Pispola J. , Cicala M. , Simeone S.
Published: December 2024

Background and Aim:

Post-cardiac surgery delirium is serious complication that affects post-operative care and patient’s quality of life. Literature has poor knowledge about the environmental and clinical risk factors of subjects undergoing cardiac surgery and the onset of delirium. Aim’s study is to identify structural and clinical factors associated with the onset of post-operative delirium in cardiac surgery.

Method:

229 patients in ICU’s cardiac surgery after cardiac surgery were enrolled in this multicenter observational study. Predictors of delirium were identified through alinear regression model.

Result:

Patient’s sample mean age of 73 years (SD=8.9), predominantly male (84.3%) and married (68.5%). Majority of patients had undergone bypass (72.9%), while 27.1% had undergone valve or endoprosthetic surgery. Logistic regression model showed that patient age, duration Vmechanically-assisted ventilation, time to exposure to artificial light, longer duration of extracorporeal circulation, blood transfusion and the presence of sleep disorders were predictors about the onset of delirium.

Conclusion:

Risk factors associated to development of delirium are multifactorial. Post- cardiac surgery delirium is potentially preventable with adequate identification of risk factors by nurses. Correctly identifying all the factors predisposing the onset of delirium can help to design a model for early identification and intervention on preventable factors.
TRANS-CATHETER CLOSURE OF NATIVE AORTIC VALVE WITH AMPLATZER OCCLUDER IN A LVAD PATIENT: STILL A RELIABLE OPTION?
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Parrella B. , De Laurentis A. , Sandoval A. , Gallone G. , Omedè P. , Pidello S. , Trompeo A. C. , Boffini M. , Rinaldi M.
Published: December 2024

Severe aortic regurgitation (AR) may occur in left ventricular assist device (LVAD) recipients. Its development is associated with increased morbidity and mortality due to timely ineffective left ventricular unloading. The optimal treatment strategy for AR remains debated, as redo open-heart surgery still results to be a high-risk procedure.

We describe the case of a 68-year-old man presenting with severe AR in a native aortic valve following continuous flow LVAD (CF-LVAD) implantation, who was not suitable for transcatheter aortic valve implantation (TAVI). Initially, he was treated by closing the aortic valve with a percutaneous aortic valve occluder (Amplatzer device) in the hybrid operating room. Ninety days later AR relapsed and he subsequently underwent surgical aortic valve replacement.
STERNAL CERCLAGE BAND SYSTEM: PRELIMINARY RESULTS OF PADUA EXPERIENCE
Authors: Tessari C. , Crea D. , Micciolo M. , Tarzia V. , Gerosa G.
Published: December 2024

Background:

Sternotomy is considered the gold standard incision in cardiac surgery. After surgery, the two sternal halves must be tightly reapproximated for proper healing, avoiding instability and wound infection. Stainless steel wires represent the gold standard, but ultra high moleculare weight polyethylene (UHMWPE) bands have been introduced into clinical practice due to their elasticity, stiffness and strength.

Aim:

To report our center’s experience with UHMWPE band system

Methods:

Prospective observational study including patients undergoing cardiac surgery through median sternotomy. Endpoints: severe complications (mediastinitis, osteomyelitis) and mild complications (superficial dehiscence).

Results:

In 21 patients (15 males, median age 65) band system was used (9 CABG, 2 AVR, 1 MVR, 2 MVP, 2 AAR, 5 combined), from 03/08/2023 to 14/12/2023. Median BMI was 26.4Kg/m2. Diabetes was present in 4 (19%), BPCO in 1 (4.8%), asthma in 1 (4.8%), active smoking in 8 (38%), osteoporosis in 2 (9.5%). Median length of hospitalization was 21 days. Both overall mortality and mortality related to the band system was null. There was no case of severe complications, of surgical revision for band-related bleeding or of re-osteosynthesis with steel wires. There were 2 (9.5%) cases of superficial dehiscence with bone instability, one of which complicated by infection and need for antibiotic. Both of them underwent closure through tightening of the same bands. Other 6 patients had only minor superficial dehiscence, without bone instability, and needed mild medications during outpatient visits.

Conclusions:

The band system is a solid and efficient method for sternal closure after median sternotomy.
SURGERY FOR NEONATES WITH UNIVENTRICULAR PHYSIOLOGY: DATA FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION CONGENITAL DATABASE
Authors: Cattapan C. , Guariento A. , Bleiweis M. , Tobota Z. , Maruszewski B. , Jacobs J. , Sarris G. , Vida V.
Published: December 2024

Background and Aim:

Patients with univentricular physiology pose a particular challenge, especially during the neonatal period. This study aimed to evaluate the outcomes of cardiac surgery in neonates with univentricular congenital heart disease (uCHD) over the past decade, using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).

Methods:

All neonates with uCHD who underwent Norwood Operation or Hybrid palliation within the first 30 days of life were selected from the ECHSA-CD database (January 2013 to December 2022). Patients who underwent exclusively percutaneous procedures were excluded. The primary outcome was operative mortality (death within the first 30 days post-operation or during the same hospitalization). Logistic regression was used to conduct a multivariable analysis.

Results:

A total of 2,700 neonatal patients with single ventricle physiology were identified in the ECHSA-CD during the study period. Hypoplastic left heart syndrome (HLHS) was the most common diagnosis (2,150/2,700=79.6%). Norwood Operation was performed in 2,115/2,700=78.3% patients and Hybrid procedure in 585/2,700=21.7% patients. While Hybrid procedure patients exhibited higher operative mortality than Norwood Operation in the overall population (182/585=31.1% vs 525/2,115=24.8%; p=0.002), this trend was reversed in patients with a body weight ≤2.5 kg (30/94=31.9% vs 38/75=50.7%, respectively; OR=0.46 (0.24-0.85) p=0.01). Patients with HLHS showed higher mortality compared to other types of uCHD (581/2,150=27.0% vs 126/550=22.9%; p=0.05).

Conclusions:

uCHD remains a significant challenge in congenital heart surgery, associated with notable mortality, especially in low-birth weight neonates.
CAN CORONARY ANATOMY INFLUENCE THE OUTCOME OF ARTERIAL SWITCH OPERATION FOR TRANSPOSITION OF THE GREAT ARTERIES?
Authors: Mangerini V. F. , Vaglio M. , Orioli V. , Careddu L. , Berardi M. , Petridis F. D. , Ragni L. , Egidy Assenza G. , Agulli M. , Schirru S. , Gargiulo G. D. , Angeli E.
Published: December 2024

Background and Aim:

ASO is choice procedure for TGA correction. The transfer of coronary artery origins is the crucial part of this operation, especially in presence of coronary anomalies that increase complexity and have an effect on postoperative outcomes. The study’s aim is to analyze the relationship between coronary anomalies and postoperative outcome.

Methods:

We retrospectively reviewed 233 pts who underwent ASO from 01/2001 to 10/2023. At operation, median age was 18,28±49,85 days and median weight 3235,97±729,99 gr. The study included TGA simple (n=158) and complex (n=75). Coronary anatomy is classified according to the Yacoub classification. The surgical technique used for coronary transplantation is trap-door technique, sometimes button technique also. The median follow-up is 8,5±6,6 years.

Results:

86 (36,9%) patients had coronary anomalies. REDO was performed in 31 (13,5%) pts, not related to the coronary arteries. 5 (2,6%) pts had a coronary stenosis, 1 required PCI. There were 4 (1.9%) in-hospital deaths (no post-discharge deaths). Overall survival was 98,1%, 97.9% and 96,8% at 1, 5 and 10 years. Coronary anatomy didn’t influence early postoperative mortality, instead intramural coronary artery and button technique coronary transplantation significantly increased mortality.

Conclusions:

ASO remains the choice procedure also for TGA with coronary anomalies with excellent in-hospital and post-discharge outcomes in terms of overall survival and freedom from reoperation. Improvements in preoperative imaging and increased surgeon experience decrease mortality associated with abnormal coronary patterns. Furthermore, pts with intramural coronary artery have higher risk for adverse postoperative outcome and must be monitored carefully.
RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION WITH BIOPULMONIC CONDUIT: A WORD OF CAUTION
Authors: Mangerini V. F. , Bartolacelli Y. , Careddu L. , Berardi M. , Egidy Assenza G. , Ragni L. , Orioli V. , Petridis F. D. , Gargiulo G. D. , Angeli E.
Published: December 2024

Background:

The most cost-benefit and affordable conduit to reconstruct right ventricle outflow tract (RVOT) is the pulmonary homograft, which is limited by the procurement and size availability. Xenograft is a good performance alternative, but the dysfunction due to progressive stenosis or regurgitation can be more frequently experienced. Aim of this study is to evaluate the mid-term outcome of Biopulmonic pulmonary conduits.

Methods:

From 08/2016 to 01/2021, 34 patients underwent RVOT reconstruction with Biopulmonic conduit, a porcine pulmonic bioprosthesis. We collected demographic data and clinical characteristics of patients and, for mid-term follow-up, freedom from conduit failure defined as stenosis or regurgitation resulting in surgical conduit change or percutaneous pulmonary valve implantation.

Results:

Mean follow-up was 14.65±14.1 months (IQR 3.8-19.8) with a freedom from conduit failure of 58,9% at 19 months. Mean gradient moved from 13.2±8.6 mmHg at 1 month to 26.3±19.6 mmHg at 12 months after surgery (p=0.0367). 11 patients (32.3%) required pulmonary valve replacement, 9 patients were treated with percutaneous valve implantation, 2 patients required surgery of whom one for endocarditis. Corticosteroid therapy in the post-operative period, used to treat pericardial effusion or no infective fever, showed to reduce the conduit dysfunction (p=0.0135).

Conclusions:

Biopulmonic conduit showed a high failure rate due to a suspected inflammatory reaction. This type of conduit should be used in selected patients and deep control of inflammatory markers is recommended.
30 YEARS OF EXPERIENCE ON GROWN-UP CONGENITAL HEART DISEASE
Authors: Maldi M. , Ghiselli S. , Arceri L. , Marianeschi S. M.
Published: December 2024

Background:

Congenital heart diseases (CHD) represent the main cause of mortality associated with defects in newborns. Due to last decades developments, 95% of children with CHD are reported to survive to adulthood. This wide population of adults, known as GUCH, now significantly exceeds the pediatric population and is continuously increasing.

Methods/Results:

We retrospectively enrolled 807 GUCH patients, aged 18 years and over, who underwent cardiac surgery between January 1993 and December 2022. Data were analyzed dividing the group into two equal periods (eras) of 15 years. Totally 836 procedures were performed on 807 patients: 574 procedures on 561 patients in the first era and 262 operations on 246 patients in the second. Mean age was 41.6 years in the first era and 36.3 years in the second. Patients undergoing operations presented with increasingly complex defects in second era. Moderate and complex diseases increased from 38.5% and 6.8% to 61.5% and 19.5%, respectively (p=0.0001 and p=0.06); simple defects were 54.7% in first era and 19.0% in second (p<0.0001). Mean Aristotle score increased from 4.9 to 6.1.

Conclusions:

The spectrum of surgery in adult CHD changed significantly over decades. We noted a significant increase of reoperations from first to second era. Surgery changed from primary repair of septal defects to complex reoperations as treatment of residual defects or sequelae of the initial pathology or previous treatment. In upcoming years, we expect that acquired heart disease will mix with adult CHD and with the onset of newer pathologies deriving from their primary surgery.
SINGLE-CENTER EXPERIENCE OF NORWOOD PROCEDURE FOR HYPOPLASTIC LEFT HEART SYNDROME: BLALOCK-TAUSSIG SHUNT OR RIGHT VENTRICLE–PULMONARY ARTERY CONDUIT?
Authors: Ruffini A. , Perri G. , Brancaccio G. , Cetrano E. , Albanese S. , Trezzi M. , Filippelli S. , D’Inzeo V. , Carotti A. , Galletti L.
Published: December 2024

Background and Aim:

Norwood procedure is used as first stage palliation in hypoplastic left heart syndrome (HLHS) or other single-ventricle lesions with systemic outflow obstruction. Evolution of this technique was focused to define the source of pulmonary blood supply. Aim of this study was to compare early and late results of Norwood using either Blalock- Taussig (BT) shunt or a right ventricle–pulmonary artery (RV-PA) conduit.

Methods:

A retrospective review of 76 patients, who underwent Norwood procedure from February 2013 to July 2024 at Bambino Gesù Children’s Hospital, was done. 24 infants received a RV-PA conduit while in 43 a BT shunt was used. 9 patients, who underwent Comprehensive Norwood after hybrid approach, were excluded. We assessed difference in surgical operative time, in-hospital mortality rates and progression to later stages of palliation.

Results:

No significant differences between two groups in mortality, hospitalization, or surgical operative time occurred. In BT group, 32 patients underwent subsequently Glenn procedure (in 11 associated to pulmonary artery enlargement and in 2 with tricuspid valve repair) and 17 advanced to Fontan palliation; in this group 3 underwent heart transplants. In RV-PA conduit group, 15 patients underwent Glenn procedure (associated in 3 to pulmonary artery plasty and in 7 to tricuspid valve repair) and 1 progressed to Fontan palliation. None needed heart transplant.

Conclusions:

There is no clear advantage of one approach over the other based on our result. Further research is needed, as Sano technique was introduced at our Center more recently compared to traditional BT shunt.
Editor's Note
Authors: Kirby Jane
Published: December 2024

The articles in this issue—focusing on critical race theory in schools, on anti-trafficking legislation that criminalizes racialized workers, and on the experiences of racialized adolescents with cancer care—point to many of the ways that racism and racialization manifest.
Desmoplastic small round cell tumor of ileum presenting as polyps: A rare presentation
Authors: Thambiraj Paruvathavarthini , Jinkala Sreerekha , Jain Ankit
Published: December 2024

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive, malignant tumor of undetermined histogenesis with a poor prognosis. Adolescent males are primarily affected with a typically abdominopelvic mass. Diagnosis is usually based on histologic analysis of biopsy and cytogenetic studies. Here, we report a 26-year-old adolescent male who presented with acute intestinal obstruction and was found to have multiple polypoidal masses in the small intestine. Histopathology showed small round cells arising from serosa infiltrating the submucosa and muscularis propria. Immunohistochemistry findings revealed positive staining for epithelial, mesenchymal, and neural markers, which confirmed the diagnosis of DSRCT. We report this rare presentation of DSRTC of the ileum with multiple polypoidal masses.
КОРМОВЫЕ И МЕТАБОЛИЧЕСКИЕ ФАКТОРЫ ФОРМИРОВАНИЯ ЖИРНОКИСЛОТНОГО СОСТАВА МОЛОКА У КОРОВ
Authors: Харитонов Е.Л. , Панюшкин Д.Е.
Published: December 2024

Цель работы − систематизация литературных и собственных данных по проблеме повышения эффективности процессов молокообразования при использовании липидов в рационе и получения молочной продукции с заданными диетическими свойствами. Основными причинными факторами изменчивости состава молочного жира являются стадия лактации, кормление, сезон года и генотип животного. Количественное соотношение образующихся жирных кислот у коров зависит от условий кормления  и запасов депонированного жира. Основные факторы, обусловливающие трансформацию кормового жира в преджелудках - это липолиз, биогидрогенизация, синтез жирных кислот микроорганизмами рубца. Производство молока контролируемого состава может быть одним из способов повышения ценности молока, предназначенного для специальных рынков. Поэтому необходимо принимать специальные меры по защите полиненасыщенных жирных кислот в рубце. Добавление в рацион “защищенных” жирных кислот значительно повышает процентное соотношение изомеров C18:1, n 9, С18:2, n 6 и C18:3, n 3, при этом снижается доля насыщенных жирных кислот, особенно C16 и C14, в молочном жире. Одной из причин возросшего спроса потребителей на коровье молоко явилось обнаружение полезных для здоровья человека эффектов у жирных кислот с сопряжёнными связями (conjugated linoleic acid  − CLA), особенно цис-9, транс-11 линолевой кислоты, содержащейся в коровьем молоке. Самыми богатыми природными источниками CLA являются мясо и молоко жвачных животных. В говядине и в коровьем молоке содержание CLA (цис-9,транс-11 линолевой кислоты) составляет около 0,62% и 0,83% от всех жирных кислот соответственно,  в молозиве −  0,3%. Молочные продукты (сливочное масло), производимые из CLA-обогащённого молока, обладают улучшенными питательными и физико-химическими свойствами, а также способствуют снижению содержания  в крови человека липопротеинов низкой плотности, что предотвращает развитие атеросклероза. Даны практические рекомендации по использованию жировых добавок в кормлении крупного рогатого скота.