Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial.

Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB.

Clinical Midterm Results of Surgical Aortic Valve Replacement with Sutureless Valves.

Background: Sutureless aortic valves may enable shorter procedure times, which benefits patients with elevated surgical risk. We describe the outcomes of patients with aortic stenosis who underwent aortic valve replacement (AVR) using the sutureless Perceval aortic bioprosthesis. Methods: Data from a retrospective cohort were obtained from a clinical database. The study enrolled patients with symptomatic severe aortic stenosis who underwent surgical AVR with a sutureless bioprosthesis between August 2015 and December 2020. In total, 113 patients were included (mean age, 75.3±8.4 years; 57.5% women; median Society of Thoracic Surgeons score, 9.7%; mean follow-up period, 51.19±20.6 months). Of these patients, 41 were octogenarians (36.2%) and 3 were nonagenarians (2.6%). Transthoracic echocardiography was employed to assess changes in ejection fraction (EF), left ventricular mass index (LVMI), and mean pressure gradient (MPG). Results: The in-hospital mortality rate was 2.6%, and 13 patients developed new-onset atrial fibrillation. A permanent pacemaker was implanted in 3 patients (2.6%). The median intensive care unit stay was 1 day (interquartile range [IQR], 1-2 days), and the median hospital stay was 12 days (IQR, 9.5-15 days). The overall survival rate at 5 years was 95.9%. LVMI and MPG were reduced postoperatively, while EF increased over the follow-up period. No structural valve deterioration was observed, and no meaningful paravalvular leakage developed during follow-up. Conclusion: The use of a sutureless valve in the aortic position is safe and feasible, even for high-risk elderly patients requiring surgical AVR. LVMI and MPG decreased postoperatively, while EF increased over the follow-up period.

Positive estrogen receptor status is a poor prognostic factor in node-negative breast cancer: An observational study in Asian patients.

ABSTRACT: This study evaluated the outcomes and prognostic factors for breast cancer according to initial lymph node (LN) status. Among patients with LN-negative breast cancer, we also focused on the prognostic value of estrogen receptor (ER) status.Medical records were retrospectively reviewed for 715 patients who underwent curative surgery for breast cancer between January 2005 and December 2015 at a single Korean institution. We evaluated factors that were associated with metastasis-free survival (MFS) according to LN status.Among the 715 patients (age: 28-87 years), 458 patients (64.1%) did not have axillary LN metastasis. Relative to patients without LN metastasis, patients with LN metastasis had larger tumor sizes and higher histological grades. Among patients with no LN metastasis, ER positivity was associated with non-significantly poorer MFS than ER negativity (mean survival: 138.90 months vs. 146.99 months, p = .17), and patients with LN-negative ER-positive disease had MFS rates of 91.7% at 5 years and 74.5% at 10 years. Among patients with LN-negative ER-positive disease, a poor prognosis was significantly associated with larger tumor size (≥2 cm, P = .03) and older age (≥50 years, P = .03).These results indicate that the risk of metastasis increases over time for patients with LN-negative ER-positive breast cancer, and especially for older patients or patients with larger tumors.

Validation of post-stenting fractional flow reserve with intravascular ultrasound parameters for optimal stent deployment.

We aimed to evaluate the relationship between post-stent fractional flow reserve (FFR) and intravascular ultrasound (IVUS) parameters for stent optimization. IVUS and FFR measurements were performed in 101 coronary lesions after successful percutaneous coronary intervention (PCI). Quantitative IVUS parameters for stent optimization such as minimal intra-stent cross sectional area (CSA), proximal, and distal reference lumen CSA, and plaque burden (PB) at both edges of the stent related to the post-stent FFR. Mean post-stent FFR was 0.91 ± 0.06. Post-stent FFR ≤ 0.90 was observed in 46 (45.5%) lesions. The 55 lesions with post-stent FFR > 0.9 had larger proximal CSA (9.2 ± 2.9 mm2 vs. 7.4 ± 2.3 mm2, p = 0.001), distal reference lumen CSA (7.4 ± 2.7 mm2 vs. 6.3 ± 2.1 mm2, p = 0.017), minimum intra-stent lumen CSA (7.4 ± 2.5 mm2 vs. 6.1 ± 1.7 mm2, p = 0.004), and lower proximal reference PB (45 ± 8.2% vs. 50 ± 11%, p = 0.017) than did those with post-stent FFR ≤ 0.90. Post-stent FFR had an inverse correlation with age, left anterior descending artery (LAD) against non-LAD, and proximal reference PB and a positive correlation with pre-stent FFR, proximal and distal reference lumen CSA, and minimum intra-stent lumen CSA. Meanwhile, no correlation was found between post-stent FFR and stent length. Pre-stent FFR (ß = 0.544), proximal reference lumen CSA (ß = 0.530) and age (ß = - 0.251) were found to be independently associated with the post-stent FFR. Post-procedural FFR might partly reflect the appropriateness of PCI results in terms of the adequate expansion of the stent and full lesion coverage on IVUS.

Measuring Intrahepatic Vascular Changes Using Contrast-Enhanced Ultrasonography to Predict the Prognosis of Alcoholic Hepatitis Combined with Cirrhosis: A Prospective Pilot Study.

Background/Aims: Acute hepatic dysfunction combined with alcoholic hepatitis (AH) in alcoholic cirrhosis is related to hepatic hypo-perfusion secondary to intrahepatic necroinflammation, neoangiogenesis, and shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) is closely correlated with the severity of intrahepatic changes. We investigated the usefulness of HVAT to predict short-term mortality of AH in cirrhosis. Methods: Thirty-nine patients with alcoholic cirrhosis (27 males) and AH were prospectively enrolled. HVAT study was performed within 3 days after admission using ultrasonic contrast (SonoVue®). The primary outcome was 12-week mortality. Results: Twelve-week mortality developed in nine patients. HVAT was significantly different between the mortality and survival groups (9.3±2.0 seconds vs 12.6±3.5 seconds, p=0.002). The odds ratio of a shortened HVAT for 12-week mortality was 1.481 (95% confidence interval, 1.050-2.090; p=0.025). The area under the receiver operating characteristic curve of HVAT for 12-week mortality was 0.787 (p=0.010). The combination of MDF and HVAT ≥11.0 seconds resulted in an 87.5% survival rate even if the MDF score ≥32; however, HVAT ＜11.0 seconds was related with mortality despite a MDF score＜32. Conclusions: HVAT using microbubble CEUS could be a useful additional index to predict short-term mortality in patients with AH and cirrhosis.

Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox.

PURPOSE: Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS: We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS: We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355-0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450-1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696-1.319) in women. CONCLUSION: In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.

Delayed Pulmonary Artery Rupture after Using BioGlue in Cardiac Surgery.

A 56-year-old woman, who underwent cardiac surgery 3 months previously, presented to the emergency room with pulmonary artery rupture due to the cytotoxic effects of BioGlue (CryoLife Inc., Kennesaw, GA, USA). She was successfully treated with surgical management. Although surgical glue can be effectively used for hemostasis, it can induce delayed vascular complications. Therefore, surgical glue should be used cautiously.

Synthesis and optical property characterization of elongated AuPt and Pt@Au metal nanoframes.

We report a facile method to synthesize elongated nanoframes consisting of Pt and Au in solution. Pentagonal Au nanorods served as templates and successfully led to an elongated AuPt nanoframe after etching the core Au. Subsequently, the coating of Au around Pt ridges resulted in Pt@Au metal nanoframes. The resulting elongated nanostructure exhibited 5 well-defined ridges continuously connected along the long axis. During the shape evolution from pure Au nanorods to elongated Pt@Au metal nanoframes, their corresponding localized surface plasmon resonance bands were monitored. Especially, unique surface plasmon features were observed for elongated Pt@Au nanoframes where the short-axis oscillation of surface free electrons is strongly coupled but the long-axis oscillation is not coupled among the ridges.

Controlling optical properties of metallic multi-shell nanoparticles through suppressed surface plasmon resonance.

Herein, we report the surface plasmon resonance of plasmonic multi-shell nanoparticles compared to bimetallic Ag/Au hollow nanospheres of similar final size, shape, and percent composition. The surface plasmon resonance of solid and hollow nanoparticles exhibited a quadrupole mode that was particularly prominent around the 100 nm size regime, while multi-shell nanoparticles did not show a quadrupole mode at a similar size. In the latter case, the quadrupole mode of the outermost nanoshell was suppressed by the dipole modes of the inner shells, and the suppression of the quadrupole mode was not affected by the shape of the inner nanostructures. Light interaction of the multi-shell nanoparticle was investigated through simulated electromagnetic field distribution obtained by finite-difference time domain (FDTD) calculations which were in a good agreement with the results of surface-enhanced Raman spectroscopy (SERS).

Na(+)-Ca(2+) exchanger targeting miR-132 prevents apoptosis of cardiomyocytes under hypoxic condition by suppressing Ca(2+) overload.

During ischemia-reperfusion (IR) injury of the heart, Ca(2+) overload occurs, leading to cardiomyocyte dysfunction and eventual cell death by apoptosis. Since preventing Ca(2+) overload during IR injury has been reported to protect cardiomyocytes, interrupting Ca(2+) signaling cascades leading to Ca(2+) overload may exert protective effect on cardiomyocytes under hypoxic condition. One of the key regulators of the intracellular Ca(2+) level during IR injury is Na(+)-Ca(2+) exchanger 1 (NCX1), whose down-regulation during IR injury conferred protection of heart. In the present study, we examined whether down-regulation of NCX1 using exogenous microRNA ameliorates apoptosis of cardiomyocytes under hypoxic condition. Here, we identified miR-132 as a novel microRNA targeting the NCX1, whose expression increased during hypoxia. Delivery of miR-132 suppressed the increase of intracellular Ca(2+) in cardiomyocytes under hypoxia, and the expressions of apoptotic molecules, such as Bax, cytochrome C, and caspase 3, and the number of apoptotic cells were also decreased by exogenous miR-132 treatment. These results suggest the potential of miR-132 as an effective therapeutic agent against IR damage to heart by preventing Ca(2+) overload during hypoxic condition and warrant further studies to validate its anti-apoptotic effect in vivo.

Close-packed two-dimensional silver nanoparticle arrays: quadrupolar and dipolar surface plasmon resonance coupling.

Silver nanoparticles (NPs) ranging in size from 40 to 100 nm were prepared in high yield by using an improved seed-mediated method. The homogeneous Ag NPs were used as building blocks for 2D assembled Ag NP arrays by using an oil/water interface. A close-packed 2D array of Ag NPs was fabricated by using packing molecules (3-mercaptopropyltrimethoxysilane) to control the interparticle spacing. The homogeneous 2D Ag NP array exhibited a strong quadrupolar cooperative plasmon mode resonance and a dipolar red-shift relative to individual Ag NPs suspended in solution. A well-arranged 2D Ag NP array was embedded in polydimethylsiloxane film and, with biaxial stretching to control the interparticle distance, concomitant variations of the quadrupolar and dipolar couplings were observed. As the interparticle distance increased, the intensity of the quadrupolar cooperative plasmon mode resonance decreased and dipolar coupling completely disappeared. The local electric field of the 2D Ag NP array was calculated by using finite difference time domain simulation and qualitatively showed agreement with the experimental measurements.

Fabrication of 2D Au nanorings with Pt framework.

Surface plasmonics of nanomaterials has been one of the main research themes in nanoscience. Spherical and elongated nanoparticles show their corresponding unique optical features mainly depending on the physical dimensions. Here we successfully synthesized Au nanorings having Pt framework (Pt@Au nanorings) with high uniformity through wet-chemistry. The synthetic strategy consisted of serial reactions involving site-selective growth of Pt on the rim of Au nanoplates, subsequent etching of Au nanoplates, followed by regrowth of Au on the Pt rim. In this synthetic method, Au(3+) ions exhibited dual functionality as an etchant and a metal precursor. The resultant product, Pt@Au nanorings, exhibited unique localized surface plasmon resonance (LSPR) bands originating from the Au shell. The inner Pt skeleton turns out to be important to hold structural stability.

Site-specific growth of a Pt shell on Au nanoplates: tailoring their surface plasmonic behavior.

In this report, we tune the surface plasmonic behavior of Au nanoplates depending on the morphology of the Pt shell in which Pt is considered as a less optically inactive element. We describe the synthesis of flat Au nanoplates coated with Pt via rim-preferential or uniform growth methods. Depending on the site-selective growth of Pt on core Au nanoplates, the aspect ratio of the resulting Au@Pt nanoplates was tunable and their corresponding surface plasmon resonance (SPR) bands were controlled accordingly. Although Pt is regarded as an optically weak component in visible and near infrared spectral windows, a Pt coating affects the SPR behavior of core Au nanoplates due to effective surface plasmon (SP) coupling between the Au core and the deposited Pt shell. We systematically investigated the optical properties of uniformly grown (Au@Pt(uni)) and rim-preferentially grown (Au@Pt(rim)) Au@Pt nanoplates by observing their SPR band shifts compared to SPR of Au nanoplates. Due to the structural rigidity conferred by the Pt coating, the Au@Pt nanoplates can be easily transferred to the investigated solvents.

Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting.

BACKGROUND: We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting. MATERIALS AND METHODS: Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo. RESULTS: In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62-4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71-16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02-4.08; P = 0.045). CONCLUSIONS: CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.

Stent versus off-pump coronary bypass grafting in the second-generation drug-eluting stent era.

BACKGROUND: Second-generation drug-eluting stents (DESs) are known to have better safety and clinical outcomes compared with the first-generation DESs. We compared the clinical results of off-pump coronary artery bypass grafting (OPCAB) with percutaneous coronary intervention (PCI) using second-generation DESs. METHODS: The study enrolled 1,821 patients with triple-vessel or left main coronary disease, or both, who underwent OPCAB or PCI with second-generation DESs from 2008 to 2011. Major adverse cardiac and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and target vessel revascularization, were retrospectively compared between the two groups in a real-world and in a matched population (n = 1,294). Follow-up duration was 23.0 ± 13.0 months (range, 0 to 56 months). RESULTS: The postprocedural mortality rate was comparable between the two groups (p = 0.384). The overall rate of MAACEs was 7.3% in the PCI group and 3.8% in the OPCAB group (p = 0.001). The 3-year rate of freedom from MACCEs was 88.4% ± 1.5% in the PCI group and 94.9% ± 1.0% in the OPCAB group (p < 0.001). In a matched population comparison, the 3-year rate of freedom from a MACCE was 87.5% ± 2.0% in the PCI group and 95.3% ± 1.2% in the OPCAB group (p = 0.001). The determining factors were nonfatal myocardial infarction and target vessel revascularization. The OPCAB group showed a superior rate of freedom from MACCEs in the triple-vessel (p = 0.008) and left main subset analysis (p = 0.001). CONCLUSIONS: The OPCAB showed superior outcomes in triple-vessel or left main disease, or both, compared with PCI in the second-generation DES era after 23 months of follow-up. Nonfatal myocardial infarction and target vessel revascularization were the determining factors. Longer follow-up with randomization will clarify our results.

Observation of a quadrupole surface plasmon mode for Au nanorods: effects of surface roughness and crystal facets.

This paper describes how the surface roughness and synthetic methods of Au nanorods affect the optical properties that are often associated with localized surface plasmon resonances. We synthesized Au nanorods with different aspect ratios and surface roughness by using two different synthetic strategies to observe surface plasmon resonance bands. One set of nanorods was prepared in high yield by using a seed-mediated dropwise-addition method with a growth-directing surfactant in aqueous solution (Au nanorods in aqueous phase, GNRA). The other set of Au nanorods were synthesized by the electrochemical deposition of Au onto an anodized aluminum oxide (AAO) template (Au nanorods by AAO template, GNRT). The length of the nanorods was controlled by changing the total charge that was passed through the cell and their diameter was monitored by changing the diameter of the template channel. The as-prepared Au nanorods were optimized to observe a quadrupole mode, which is one of the higher-order surface plasmon bands. Our results showed differences between the optical properties of GNRA and GNRT. The roughness and crystal structure of the Au nanorods affected their optical properties. Smooth and single-crystal surface on GNRA had larger and sharper peaks than GNRT. The discrete dipole approximation (DDA) method was used to calculate the optical properties of the Au nanorods and these results were in good agreement with our experimental results.

Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: a prospective observational study.

BACKGROUND: The effect of prosthesis-patient mismatch (PPM) on clinical outcomes after aortic valve replacement remains controversial. We evaluated effect of PPM on long-term clinical outcomes after isolated aortic valve replacement in patients with predominant aortic stenosis. METHODS: We analyzed data from patients with predominant aortic stenosis who underwent isolated aortic valve replacement between January 1995 and July 2010. The indexed effective orifice area, obtained by dividing the in vivo effective orifice area by the patient's body surface area, was used to define PPM as clinically nonsignificant (group I, 224 patients), mild (group II, 52 patients), moderate (group III, 39 patients), and severe (group IV, 36 patients). RESULTS: Early survival was not significantly different among the groups, but overall survival was decreased gradually in group IV. Overall survival at 12 years was lower in group IV than in group I (92.8% ± 2.7% vs 67.0 ± 10.1, respectively; P = .001). Cardiac-related-death-free survival at 12 years was lower in patients with severe PPM. Left ventricular mass index decreased during the follow-up period in all groups. But left ventricular mass index was less decreased in group IV compared with groups I, II, and III. Age, severe PPM, and ejection fraction <40%, and New York Heart Association Functional Class IV were independent risk factors of overall survival on multivariate analysis. Severe PPM was an independent risk factor for cardiac-related death. CONCLUSIONS: Severe PPM showed an adverse effect on long-term survival, and was an independent risk factor for cardiac-related death. In addition, patients with severe PPM showed less decreasing left ventricular mass index during follow-up.

Influence of iodide ions on morphology of silver growth on gold hexagonal nanoplates.

Different morphologies of Au@Ag nanocrystals have been successfully synthesized using iodide ions in growth solutions consisting of ascorbic acid, NaOH, and CTAB. Without I(-) ions in growth solution, there were unnoticeable changes in morphology. On the other hand, with addition of I(-) ions, remarkable changes were observed including formation of hexagonal bipyramidal nanocrystals. Ag(+) ions were reduced and deposited on {111} facets of gold hexagonal nanoplates (GHNs), and hexagonal bipyramidal nanoparticles were formed more quickly in the presence of I(-) ions than without I(-) ions. Our studies reveal that I(-) ion affects the selective growth of Ag onto GHNs. This can be explained by the decrease in the surface redox potential of nanocrystals that occurs by combining with the AgI complex on the metallic surface. These results were confirmed by FESEM images, UV-vis-NIR spectra, and TEM images.