Decoding the Rejection Code: Understanding Why Articles Get Axed.

In the competitive arena of medical publishing, manuscript rejection remains a significant barrier to disseminating research findings. This editorial delves into the multifaceted nature of manuscript rejection, elucidating common reasons and proposing actionable strategies for authors to enhance their chances of acceptance. Key rejection factors include a mismatch with journal scope, lack of novelty, methodological flaws, inconclusive results, ethical issues, poor presentation, data inaccessibility, author misconduct, and plagiarism. Ethical lapses, such as lacking informed consent, or submissions fraught with grammatical errors, further doom manuscripts. In addressing these pitfalls, authors are advised to ensure content originality, methodological rigor, ethical compliance, and clear presentation. Aligning the manuscript with the journal's audience, scope, and editorial standards is crucial, as is professional conduct and responsiveness to feedback. Leveraging technological tools for citation management, grammar checking, and plagiarism detection can also significantly bolster manuscript quality. Ultimately, understanding and addressing common rejection reasons can empower authors to improve their submissions, contributing to the advancement of medical knowledge and their professional growth.

Beyond Synthetics: Promising Outcomes With the Invengenx® Bovine Pericardial Patch for Ventricular Septal Defect Repair in a Young Pediatric Population.

Ventricular septal defects (VSDs) are a prevalent congenital heart anomaly demanding safe and lasting interventions. This paper explores the application of Invengenx® bovine pericardial patch (Tisgenx, Irvine, California), a promising biomaterial, in VSD repair. We present two case studies: a seven-month-old infant and a three-year-old child undergoing VSD closure using autologous and bovine pericardial patches, respectively. Both patients tolerated the procedures well, experiencing no intra-operative complications and demonstrating excellent postoperative recovery. Echocardiography postoperatively showed no complications and improved clinical outcomes. Notably, the pericardial patches exhibited excellent integration and suture retention, highlighting their durability and compatibility with the growing heart. These cases establish the feasibility and effectiveness of the Invengenx® pericardial patch for VSD repair. The favorable outcomes in terms of safety and efficacy support the potential of this biomaterial as a valuable alternative in pediatric cardiac surgery, particularly for complex VSDs or patients with contraindications to synthetic patches. Further research is crucial to unlock the full potential of bovine pericardium as a durable and advantageous option for VSD repair in a broader range of pediatric patients.

Statistics in the Operating Room: A Cardiovascular Surgeon's Guide to Numbers That Matter.

Pediatric cardiac surgery demands meticulous technique, but optimal outcomes hinge on translating data into actionable insights. This editorial bridges the gap between scalpel and statistical jargon, empowering surgeons to decipher common tests. Descriptive statistics paint portraits of patient cohorts, while hypothesis testing discerns real differences from chance. Regression analysis unveils hidden relationships, predicting outcomes based on complex interplays of variables. Survival analysis tracks the delicate dance of time and survival, informing therapeutic strategies. By embracing statistical fluency, surgeons become architects of personalized care, tailoring interventions to mitigate risks and maximize the precious gift of a beating heart.

The Myths, Perils, and Pitfalls of Redo Pediatric Cardiac Surgery: The New Normal in Developing Countries Such as India.

Pediatric patients undergoing reoperative cardiac surgery after a previous sternotomy face a higher degree of surgical complexity compared to those undergoing initial procedures. They have higher intraoperative and postoperative risks. The increased risk of surgery is due to preoperative patient factors and intraoperative technical challenges. Redo-pediatric cardiac surgery is a common event in almost every pediatric cardiac surgeon's professional life. Redo-surgery is almost inevitable in patients who have multi-stage repair of congenital heart surgeries and biological valves at a young age, and often in those having valve repair in rheumatic disease. So, being familiar with the pitfalls and precautions to be taken is of crucial importance. In general, the patients presenting for repeat procedures are sicker, older, and have more comorbid conditions. The dissection is always rendered difficult by adhesions, scarring, and previous graft placements. Hence, prolonged dissection time, intraoperative injuries to heart chambers, great vessels, and grafts, increased bleeding, and poorer cardiac function result in higher morbidity and mortality in such subsets of patients. The outcome is worse with emergency redo-cardiac surgeries.

The Utility of Invengenx® Bovine Patch for Right Ventricular Outflow Tract (RVOT) Reconstruction and Augmentation in the Surgical Management of Tetralogy of Fallot (TOF): A Contemporary Study and Review of the Literature.

Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right ventricular outflow tract (RVOT). This procedure requires the use of both synthetic and natural materials. However, finding the ideal material for tissue implants can be challenging. Biological materials often face issues such as tissue degeneration, calcium deposition, antigenicity, rejection, shrinkage, and fibrosis. These issues can lead to complications such as stenosis and insufficiency, potentially requiring early reoperations. In light of this, this study aimed to investigate the effectiveness of the Invengenx® bovine patch for RVOT reconstruction and augmentation. Methods This was a retrospective observational study conducted among eight children who underwent TOF correction cardiac surgery. Their demographic and clinical characteristics, intraoperative findings, and postoperative follow-up results at six months were collected from the hospital patient database. Results There were no deaths or complications in this study. We observed a significant reduction in the gradient across the pulmonary valve and the outflow tract at six months post-procedure. The analysis demonstrated that the Invengenx® bovine patch was successful and did not lead to any complications. Conclusions This study demonstrates the safety and efficacy of this engineered bovine pericardial patch (Invengenx®) as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects.

Outcome Prediction of TBI: Are There Parameters That Affect the IMPACT and CRASH Models?

BACKGROUND: Abnormal hematologic parameters associated with unfavorable neurological outcomes in traumatic brain injury (TBI) have been studied in isolation. We aimed to study whether there are any additional parameters that improve standard prognostic models in TBI. METHODS: This prospective observational study conducted in a tertiary neurological care center included adult patients with moderate and severe isolated head injury. Laboratory and clinical parameters were noted at admission, and the Glasgow Outcome Score-Extended of patients was assessed after 6 months. Multiple logistic regression was conducted using fixed coefficients of IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) and CRASH (Corticosteroid Randomisation After Significant Head Injury) prognostic models. The new composite models were compared with the original models. RESULTS: The study comprised 96 patients. Parameters with relatively good predictability for mortality were elevated international normalized ratio (area under the curve [AUC] 0.69, odds ratio 13.2), total leukocyte count (AUC 0.68, odds ratio 1.15), and transfusion of blood products (AUC 0.72, odds ratio 6.43). Addition of these led to a statistically small improvement in predictions of IMPACT and CRASH. Neutrophil-to-lymphocyte ratio was not a good predictor of mortality or morbidity (AUC 0.58 and 0.47, respectively). CONCLUSIONS: International normalized ratio, total leukocyte count, and blood transfusion were found to be predictors of mortality and unfavorable neurological outcome in TBI at 6 months. Their addition to the IMPACT and CRASH prognostic models resulted in a modest improvement in the prediction of outcome in TBI.

Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: A randomized controlled trial.

BACKGROUND: The objective of this study was to study and compare the effects of intravenous dexmedetomidine and fentanyl on intraoperative hemodynamics, opioid consumption, and recovery characteristics in hypertensive patients. METHODS: Fifty-seven hypertensive patients undergoing major surgery were randomized into two groups, Group D (dexmedetomidine, n = 29) and Group F (fentanyl, n = 28). The patients received 1 µg/kg of either dexmedetomidine or fentanyl, followed by 0.5 µg/kg/h infusion of the same drug, followed by a standard induction protocol. Heart rate (HR), mean arterial pressures (MAPs), end-tidal isoflurane concentration, and use of additional fentanyl and vasopressors were recorded throughout. RESULTS: Both dexmedetomidine and fentanyl caused significant fall in HR and MAP after induction and dexmedetomidine significantly reduced the induction dose of thiopentone (P = 0.026). After laryngoscopy and intubation, patients in Group D experienced a fall in HR and a small rise in MAP (P = 0.094) while those in Group F showed significant rise in HR (P = 0.01) and MAP (P = 0.004). The requirement of isoflurane and fentanyl boluses was significantly less in Group D. The duration of postoperative analgesia was longer in Group D (P = 0.015) with significantly lower postoperative nausea and vomiting (PONV) (P < 0.001). CONCLUSION: Infusion of dexmedetomidine in hypertensive patients controlled the sympathetic stress response better than fentanyl and provided stable intraoperative hemodynamics. It reduced the dose of thiopentone, requirement of isoflurane and fentanyl boluses. The postoperative analgesia was prolonged, and incidence of PONV was less in patients who received dexmedetomidine.

Assessing the risk for development of Venous Thromboembolism (VTE) in surgical patients using Adapted Caprini scoring system.

AIM: To determine the incidence, morbidity and mortality due to Venous Thromboembolism (VTE) in surgical patients, and to assess the validity and reliability of Adapted Caprini scoring in risk stratification for VTE prophylaxis. METHODOLOGY: This was a prospective observational study in a tertiary care hospital of South India on patients who underwent both elective and emergency surgeries over a period of 9 months. An Adapted Caprini score was devised which included only the clinical criteria. The patients were scored by two persons independently at admission and followed up till the 30th post-operative day and primary and secondary end points were statistically analyzed. RESULTS: Three hundred and one patients were included and the overall incidence of VTE at 30 days was 7.3%. The risk of developing VTE was found to be significantly higher among the >8 score group as compared to 3-4 group (OR = 153.5, p < 0.001), or the 5-6 group (OR = 52.9, p < 0.001) or the 7-8 group (OR = 2.3, p = 0.002). Patients with a score of 7-8 were more likely to develop VTE as compared to 3-4 group (OR = 67.5, p < 0.001) or the 5-6 group (OR = 23.2, p < 0.001). CONCLUSION: The risk of developing VTE is less significant in the 5-6 score group compared to 7-8 or more score group. Further stratification of the highest risk groups is recommended to provide appropriate prophylaxis only to the patients with high scores, thereby reducing complications due to VTE prophylaxis.