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The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion.
A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed.
During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without air-lock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5-and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up.
Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery.
Our results show that performing tricuspid surgery without caval occlusion is safe. Entinostat ic50 The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery.
To investigate the efficacy of pre-emptive remifentanil in alleviating pain during tracheal suctioning in patients under mechanical ventilation.
Goal-directed sedation is recommended for patients under mechanical ventilation by the current guidelines. Whether goal-directed sedation can prevent pain during tracheal suctioning in these patients is unknown.
This was a two-centre, randomized, crossover, single-blind trial conducted between August and October 2019.
Patients under mechanical ventilation received low-dose remifentanil, high-dose remifentanil or placebo prior to each tracheal suctioning in a random order. The primary outcomes were evaluated using the critical-care pain observation tool and Richmond agitation-sedation scale after tracheal suctioning. Adverse events were also documented.
A total of 39 patients who underwent 117 tracheal suctions were enrolled. After the tracheal suction, changes in the critical-care pain observation tool and Richmond agitation-sedation scale scores were significantly lower in the low-dose and high-dose groups than in the placebo group (P < 0.001). A non-significant increase in the absence of spontaneous breathing was observed in the high-dose group compared to that in the placebo group.
A pre-emptive remifentanil bolus of 0.5 μg/kg can mitigate the pain associated with tracheal suctioning.
A pre-emptive remifentanil bolus of 0.5 μg/kg can mitigate the pain associated with tracheal suctioning.A magnetic CdS quantum dot (Fe3 O4 /polydopamine (PDA)/CdS) was synthesized through a facile and convenient method from inexpensive starting materials. Characterization of the prepared catalyst was performed by means of FTIR spectroscopy, XRD, SEM, TEM, energy-dispersive X-ray spectroscopy, and vibrating-sample magnetometer techniques. Fe3 O4 /PDA/CdS was found to be a highly active photocatalyst for the amidation of aromatic aldehydes by using air as a clean oxidant under mild conditions. The photocatalyst can be recovered by magnetic separation and successfully reused for five cycles without considerable loss of its catalytic activity.H2 adsorption on Au catalysts is weak and reversible, making it difficult to quantitatively study. We demonstrate H2 adsorption on Au/TiO2 catalysts results in electron transfer to the support, inducing shifts in the FTIR background. This broad background absorbance (BBA) signal is used to quantify H2 adsorption; adsorption equilibrium constants are comparable to volumetric adsorption measurements. H2 adsorption kinetics measured with the BBA show a lower Eapp value (23 kJ mol-1 ) for H2 adsorption than previously reported from proxy H/D exchange (33 kJ mol-1 ). We also identify a previously unreported H-O-H bending vibration associated with proton adsorption on electronically distinct Ti-OH metal-support interface sites, providing new insight into the nature and dynamics of H2 adsorption at the Au/TiO2 interface.Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24-h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02-0.29). Patients using icodextrin had a higher ratio (0.16 (0.03-0.32) versus 0.11 (-0.02-0.26), P  less then  .001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06-0.32) versus 0.13 (-0.01-0.19), P  less then  .01), and CAPD versus APD (0.18 (0.05-0.36) versus 0.11 (0.0-0.27), P  less then  .05), respectively. A multivariable model showed that 24-h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9-14.8]), P  less then  .001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06-0.62), P  less then  .01 and increased extracellular water to total body water (OR 0.001 [0-0.08], P = .03) were associated with lower ratios. Twenty four-hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption.