Novel Trilaminar Polymeric Antiadhesion Membrane Prevents Postoperative Pericardial Adhesion.

BACKGROUND: Postoperative pericardial adhesion formation is a prominent cause of morbidity and death in cardiovascular surgery, but there is still no ideal prevention method, especially in redo cases. This study investigated a novel antiadhesion trilaminar polymeric film compared with the Gore PRECLUDE Pericardial Membrane (W. L. Gore & Associates, Flagstaff, AZ) and a negative control. METHODS: Our novel trilaminar membrane is composed of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC). An established pericardial adhesion rabbit model was used to test the property of the membrane. After sternotomy, a portion of pericardium was resected and the epicardium was abraded. Rabbits (n = 24) were randomly assigned to 3 groups: control group, no trilaminar membrane or expanded polytetrafluoroethylene (ePTFE); ePTFE group, or trilaminar membrane group (PVA-CMC group). Evaluation of adhesion formation was performed by resternotomy 4 weeks after the operation. RESULTS: The degree of tissue adhesion surrounding the heart in the PVA-CMC group was significantly less than in the control (P < .01) and ePTFE (P < .05) groups. The inflammation score in group PVA-CMC was significantly lower than that in the ePTFE (P < .01) and control (P < .01) groups. The fibrosis score was significantly lower in group PVA-CMC than that in the ePTFE (P < .05) and control (P < .01) groups. CONCLUSIONS: The novel trilaminar membrane effectively reduced postoperative pericardial adhesions. The placement of the trilaminar membrane at the time of sternal closure provides a novel combination to minimize the extent and severity of pericardial adhesions while providing a physical barrier between the sternum and the cardiac structures.

Emerging predictors of femoral artery occlusion after pediatric cardiac catheterization.

The Objective was to review the prevalence of femoral artery occlusion (FAO) after cardiac catheterization in children up to 12 years old from two centers in China and identify its related risk factors. After collecting clinical data from patients who had undergone pediatric cardiac catheterization, univariate and multivariate analysis were used to evaluate the correlations between FAO and clinical factors, including sex, age, height, weight, sheath size, operation time, therapeutic strategy, sheath/age, sheath/height and sheath/weight. The ROC curve was also used to assess the influence of risk factors to predict FAO. FAO occurred in 19 (0.9%) out of 2,084 children following cardiac catheterization. Patients with younger age, lower height, longer operation time, electrophysiological (EP) diagnosis or/and therapy for arrhythmias, higher Sheath/Age, higher Sheath/Height and higher Sheath/Weight ratios had higher risk for FAO compared to their respective control groups (p < 0.05). In the multivariate analysis, sheath/age and operation time were independent risk factors for FAO. Patients with operation time > 77.5 min or sheath/age > 0.5334 had a significantly higher risk for FAO. Operation time and sheath/age were confirmed as significant and independent risk factors associated with FAO. Operation time > 77.5 min and sheath/age > 0.5334 could effectively predict high risk of FAO after pediatric cardiac catheterization.

The modified 'no touch' technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting.

BACKGROUND: Open surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The 'no touch' technique used in the renal artery was modified for this situation. METHODS: Fifteen selective LCCA stenosis patients were treated by the modified 'no touch' technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a 'bovine aortic arch'. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months. RESULTS: The initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound. CONCLUSIONS: The modified 'no touch' antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.

Deletion in exon 5 of the SNCA gene and exposure to rotenone leads to oligomerization of α-synuclein and toxicity to PC12 cells.

α-Synuclein (α-syn) is a presynaptic protein that is widely implicated in the pathophysiology of Parkinson's disease (PD). Recently, four α-syn isoforms that are produced by alternative splicing have been described, they are α-syn140, α-syn126, α-syn112, and α-syn98. The stable cell lines which expressed the four α-syn isoforms respectively were obtained, and the aggregation formation of these α-syn isoforms and their associated toxicity to PC12 cell were investigated. The results of this study indicate that over-expression of α-syn isoforms alone in dopaminergic cells have no effect on the formation of α-syn oligomeric species and cell viabilities. When exposed to rotenone, these cell lines which over expressed exon 5-lacking form of α-syn isoforms showed the formation of oligomeric species and toxicity to PC12 cells.

Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice.

BACKGROUND: Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening. METHODS: We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50-75 years old recruited from an academic internal medicine practice. RESULTS: Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask) before viewing the decision aid to 3.2 afterwards (difference, 0.4; p < 0.0001, paired t-test). Most found the aid useful and reported that it improved their knowledge about screening. Sixty percent said they were ready to be tested, 18% needed more information, and 22% were not ready to be screened. Within 6 months of viewing, 43% of patients had completed screening tests. CONCLUSION: We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening. PRACTICE IMPLICATIONS: This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels.