Antegrade Cardioplegia Decannulation Made Simple With the Cor-Knot System: Technique and Tips After 20 Consecutive and Controlled Patients

Closing the cardioplegia cannulation site can be challenging in minimally invasive video-assisted cardiac surgery. The Cor-Knot system is used to tie down valve sutures within the heart efficiently, although erosions to neighboring structures are reported. We hypothesized that a modification of the Cor-Knot system could enable safe hemostasis of the cardioplegia aortic root site and avoid erosions of the aorta or right atrium. This is a single-arm prospective study including 20 consecutive patients operated through a video-assisted method at our clinic between January 2019 and February 2019. At the end of the procedure, the suture was passed through a Cor-Knot device and crimped on a band of Teflon-felt. The two tips of the Teflon-felt toward the right atrium were put together and tightened with a 5/0 Prolene suture in order to protect the sharp ends of the device. Hemostasis was achieved using the technique in all 20 patients, with no requirement for further suture placement to ensure hemostasis of the cardioplegia cannulation site. The device was protected from the right atrial appendage and there was no bleeding. At 6-month follow-up, no patients required a reoperation for aortic or right atrial erosion. The Cor-Knot system was used off-label to close the cardioplegia cannulation site in minimally invasive surgery. This appears safe and effective in our initial 20-patient experience.

The influence of diet therapeutic intervention on the sarcopenic index of patients with metabolic syndrome

Introduction

The published data showed the importance of metabolic control in preventing complications in metabolic syndrome (MS) and the role of nutritional medical therapy in glycemic control and in the control of dyslipidemia, hypertension, weight loss/normalization (in overweight or malnourished subjects).

Objectives

This study follows the evolution of sarcopenic index (SI) and other clinical parameters (body mass index (BMI), homeostasis evaluation index (HOMA index)) correlated with MS after diet therapy or diet therapy combined with sports, in patients with MS.

Patients and methods

Our research was conducted during 12 months, on 110 patients >18 years of age, with HOMA index>2, divided into three groups: control group (CG, N=20), diet therapy group (DTG, N=58), diet therapy and sports group (DTSG, N=32). HOMA index for insulin resistance was calculated as the product of resting plasma insulin (in microunits/milliliter) and plasma glucose (in millimoles/liter), divided by 22.5. SI was determined using BIA, as being the ratio between muscle mass and fat mass, measured in cm²/m².

Results

A significant decrease of BMI (p<0.05) in DTG (from 31.63 to 24.50) and DTSG (from 30.18 to 24.17) vs. CG was observed (Pearson coefficient r=0.281, p<0.001). Weight status changed significantly (p<0.05) in the high-risk patients. There was a significant decrease of HOMA index (p<0.05) in DTG (from 5.93 to 2.57), DTSG (from 3.93 to 2.23), and in CG an increase was observed (from 3.15 to 3.37).

Conclusion

The best results in the prevention/ treatment of sarcopenia in MS patients were obtained for DTSG, which benefited from both the positive effect of diet and physical activity.

Thermal Degradation Behavior of Polymer Blends Based on Poly(Ester Urethane)s

Thermal degradation behavior of blends based on a poly(ester urethane) and poly(ether sulfone) with or without poly(urethane sulfone) taken as a compatibilizer was investigated by thermogravimetric analysis under dynamic conditions. The theoretical mass loss curves were compared with the experimental ones in order to see the influence of blending on the thermal stabilities. The resulting data together with analysis of activation energies demonstrated that the presence of polysulfone caused a rise in thermal stability, interactions appear during degradation and the compatibilizer influences the thermal behavior of the studied blends.

Interpenetrating poly(urethane-urea)–polydimethylsiloxane networks designed as active elements in electromechanical transducers

Original interpenetrating polymer networks suitable for active dielectric elements in actuation devices were prepared by using a dual compatibilization pathway.

Aging behavior of the silicone dielectric elastomers in a simulated marine environment

A series of silicone–barium titanate composites, designed as dielectric elastomer films to be used as active elements in wave energy conversion devices, were immersed in artificial sea water in pseudo-dynamic conditions to asses their aging behavior.

Thermal behavior, surface energy analysis, and hemocompatibility of some polycarbonate urethanes for cardiac engineering

The understanding of basic surface properties and the relationships between temperature and the configuration of the polymer surface are the key to further understand the first interaction mechanism of the polymer with the body. To this end, some poly(carbonate tetramethylene ether)urethane (PCEU), poly(carbonate siloxane tetramethylene ether)urethane (PCSiEU), and their 1:1 gravimetric mixture (PCEU/PCSiEU) membranes were prepared. In order to establish the relationships between temperature and the chemical structure of polymer surface, the polyurethane (PU) membranes were analyzed by attenuated total reflectance–Fourier transform infrared spectroscopy. The temperature has a significant influence on these PU surface structures. Surface characteristics such as wettability and surface free energy were also analyzed since the interaction between biomaterials and blood occurs at their interface. The preliminary cytotoxicity screening showed no cytotoxicity of these PU membranes. The PU samples do not accelerate the clot formation mechanisms under the tested conditions. The results suggest that these PU membranes are promising materials for the preparation of cardiovascular scaffolds.

Polar–nonpolar interconnected elastic networks with increased permittivity and high breakdown fields for dielectric elastomer transducers

Polysiloxanes with polar cyano groups were cross-linked with PDMS by a hydrolysis–condensation process. Materials suitable for transducer applications with improved permittivity, good mechanical properties, and high breakdown fields were obtained.

Silicone–barium titanate composites with increased electromechanical sensitivity. The effects of the filler morphology

Dielectric elastomers were prepared on the basis of high molecular weight polydimethylsiloxane-α,ω-diol filled with barium titanate particles having well-defined size and morphology.

Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations

OBJECTIVE

To make recommendations on how to report disease activity in clinical trials of rheumatoid arthritis (RA) endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).

METHODS

The project followed the EULAR standardised operating procedures, which use a three-step approach: (1) expert-based definition of relevant research questions (November 2006); (2) systematic literature search (November 2006 to May 2007); and (3) expert consensus on recommendations based on the literature search results (May 2007). In addition, since this is the first joint EULAR/ACR publication on recommendations, an extra step included a meeting with an ACR panel to approve the recommendations elaborated by the expert group (August 2007).

RESULTS

Eleven relevant questions were identified for the literature search. Based on the evidence from the literature the expert panel recommended that each trial should report the following items: (1) disease activity response and disease activity states; (2) appropriate descriptive statistics of the baseline, the endpoints and change of the single variables included in the core set; (3) baseline disease activity levels (in general); (4) the percentage of patients achieving a low disease activity state and remission; (5) time to onset of the primary outcome; (6) sustainability of the primary outcome; (7) fatigue.

CONCLUSIONS

These recommendations endorsed by EULAR and ACR will help harmonise the presentations of results from clinical trials. Adherence to these recommendations will provide the readership of clinical trials with more details of important outcomes, while the higher level of homogeneity may facilitate the comparison of outcomes across different trials and pooling of trial results, such as in meta-analyses.