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Remote surgery

G Fenna van Breda, Lennart G Bongartz, Wenqing Zhuang, Rachel P L van Swelm, Jeanne Pertijs, Branko Braam, Maarten-Jan Cramer, Dorine W Swinkels, Pieter A Doevendans, Marianne C Verhaar, Roos Masereeuw, Jaap A Joles, Carlo A J M Gaillard
BACKGROUND: Hepcidin regulates systemic iron homeostasis by downregulating the iron exporter ferroportin. Circulating hepcidin is mainly derived from the liver but hepcidin is also produced in the heart. We studied the differential and local regulation of hepcidin gene expression in response to myocardial infarction (MI) and/or chronic kidney disease (CKD). We hypothesized that cardiac hepcidin gene expression is induced by and regulated to severity of cardiac injury, either through direct (MI) or remote (CKD) stimuli, as well as through increased local iron content...
October 22, 2016: American Journal of Nephrology
Christian Stoppe, Patrick Meybohm, Andreas Goetzenich
The strategy of Remote Ischaemic Conditionings (RIC) is easy to apply, cost effective, low in side effects and belongs to the most potent cardioprotective strategies evaluated within recent years. Its practical application is carried out by simple use of a blood pressure cuff, more precise by 4 repetitive cycles of inflating the cuff above 200 mmHg for 5 minutes followed by an equal long break between the cycles. First experimental and clinical data repetitively demonstrated a significant reduction in myocardial injury following ischemia/reperfusion...
October 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Michele Malagù, Alessandra Ferri, Ottavia Mancuso, Filippo Trevisan, Marianna Nardozza, Matteo Bertini
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures...
October 20, 2016: Future Cardiology
Robert Battat, Marc Jhonson, Lorne Wiseblatt, Cruff Renard, Laura Habib, Manouchka Normil, Brian Remillard, Timothy F Brewer, Galit Sacajiu
BACKGROUND: Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti...
October 19, 2016: BMC Medical Education
William S Duke, F Christopher Holsinger, Emad Kandil, Jeremy D Richmon, Michael C Singer, David J Terris
BACKGROUND: Robotic facelift thyroidectomy (RFT) was developed as a new surgical approach to the thyroid gland using a remote incision site. Early favorable results led to this confirmatory multi-institutional experience. METHODS: Prospectively collected data on consecutive patients undergoing RFT in five North American academic endocrine surgical practices were compiled. Surgical indications, operative times, final pathology, nodule size, complications, and postoperative management (drain use and length of hospital stay) were evaluated...
October 13, 2016: World Journal of Surgery
M M Petrova, S V Prokopenko, O V Eremina, E Yu Mozheiko, D S Kaskaeva
AIM: To evaluate the efficacy of computer-based stimulation programs in the correction of postoperative cognitive dysfunction in patients with ischemic heart disease in remote period after coronary artery bypass surgery. MATERIAL AND METHODS: The study involved 74 patients. All patients underwent a drug therapy and the rehabilitation course using computer-based stimulation programs (1 time per day for 20 minutes during10 days). Coronary artery bypass surgery was performed for all patients...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
David J Keene, Dipesh Mistry, Julian Nam, Elizabeth Tutton, Robert Handley, Lesley Morgan, Emma Roberts, Bridget Gray, Andrew Briggs, Ranjit Lall, Tim Js Chesser, Ian Pallister, Sarah E Lamb, Keith Willett
BACKGROUND: Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES: We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN: A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study...
October 2016: Health Technology Assessment: HTA
Yader Sandoval, Marina Zakharova, Thomas S Rector, Emmanouil S Brilakis, Todd Drexel, Edward O McFalls, Santiago Garcia
The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant...
September 15, 2016: American Journal of Cardiology
B S Sukovatykh, L N Belikov, M B Sukovatykh, D V Sidorov, M A Inarkhov, E B Inokhodova
AIM: to improve treatment of patients with severe atherosclerotic lesion of lower extremities arteries followed by critical ischemia by optimization of femoropopliteal bypass surgery. MATERIAL AND METHODS: Treament and survey of 60 patients with severe atherosclerotic lesion of femoropopliteotibial segment and critical lower limb ischemia were analyzed. Patients were divided into 2 groups depending on technique of femoropopliteal bypass. Conventional in situ autovenous technique was used in group 1...
2016: Khirurgiia
Mariana Mirabel, Matthias Lachaud, Lucile Offredo, Cécile Lachaud, Benjamin Zuschmidt, Beatriz Ferreira, Daniel Sidi, Sylvain Chauvaud, Phang Sok, Alain Deloche, Eloi Marijon, Xavier Jouven
BACKGROUND: Access to cardiac surgery is limited in low-income settings, and data on patient outcomes are scarce. AIMS: To assess characteristics, surgical procedures and outcomes in patients undergoing open-heart surgery in low-income settings. METHODS: This was a cohort study (2001-2011) in two low-income countries, Cambodia and Mozambique, where cardiac surgery had been promoted by visiting non-governmental organizations. RESULTS: In Cambodia and Mozambique, respectively, 1332 and 767 consecutive patients were included; 547 (41...
October 3, 2016: Archives of Cardiovascular Diseases
Nicoline Valentina Krogstrup, Mihai Oltean, Gertrude J Nieuwenhuijs-Moeke, Frank J M F Dor, Ulla Møldrup, Søren Palmelund Krag, Bo Martin Bibby, Henrik Birn, Bente Jespersen
Delayed graft function is a frequent complication following deceased donor renal transplantation, and is closely related to ischaemia-reperfusion injury. Experimental and clinical studies have shown protection by remote ischaemic conditioning (RIC). We hypothesised that recipient RIC before kidney graft reperfusion reduces the time to graft recovery. This multicentre, blinded, randomised, controlled clinical trial included 225 adult recipients of renal transplants from deceased donors at four transplantation centres in Denmark, Sweden and the Netherlands...
October 3, 2016: American Journal of Transplantation
Hamed Asadi, Hong Kuan Kok, Seamus Looby, Paul Brennan, Alan O'Hare, John Thornton
PURPOSE: This study aims to identify factors influencing outcome in brain arteriovenous malformations (BAVM) treated with endovascular embolisation. We also assessed the feasibility of using machine learning techniques to prognosticate and predict outcome and compared this to conventional statistical analyses. METHODS: A retrospective study of patients undergoing endovascular treatment of BAVM over a 22-year period in a national neuroscience centre was performed...
September 28, 2016: World Neurosurgery
Santiago Garcia, Thomas S Rector, Marina Zakharova, Rebekah R Herrmann, Selcuk Adabag, Stefan Bertog, Yader Sandoval, Steve Santilli, Emmanouil S Brilakis, Edward O McFalls
BACKGROUND: Remote ischemic preconditioning (RIPC) has been shown to reduce infarct size in animal models. We hypothesized that RIPC before an elective vascular operation would reduce the incidence and amount of a postoperative rise of the cardiac troponin level. METHODS AND RESULTS: Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES) was a prospective, randomized, sham-controlled phase 2 trial using RIPC before elective vascular procedures...
2016: Journal of the American Heart Association
Peter Onody, Peter Aranyi, Zsolt Turoczi, Rita Stangl, Andras Fulop, Emese Dudas, Gabor Lotz, Attila Szijarto
AIMS AND OBJECTIVES: Acute renal failure is a severe complication of lower extremity major arterial reconstructions, which could even be fatal. Levosimendan is a dual-acting positive inotropic and vasodilatory agent, which is suspected to have protective effects against cardiac ischemia. However, there is no data available on lower limb or remote organ ischemic injuries therefore the aim of the study was to investigate the effect of levosimendan on lower limb ischemia-reperfusion injury and the corollary renal dysfunction...
2016: PloS One
Chester E Sutterlin
At noon on Saturday, 25 April 2015, a 7.8 magnitude earthquake struck Nepal. It was centered in the Himalaya northwest of Kathmandu, the capital of over 1 million people. The violent tremors were felt as far away as New Delhi, India 1,000 km from the epicenter, but the worst of its destructive force was experienced in the heavily populated Kathmandu valley and in the remote mountainous villages of the Himalaya. Ancient temples crumbled; poorly constructed buildings collapsed; men, women, and children were trapped and injured, sometimes fatally...
December 2015: J Spine Surg
Patrick M Honore, Rita Jacobs, Herbert D Spapen
No abstract text is available yet for this article.
August 2016: Annals of Translational Medicine
Feryal Erhun, Elizabeth Malcolm, Maziyar Kalani, Kimberly Brayton, Christine Nguyen, Steven M Asch, Terry Platchek, Arnold Milstein
OBJECTIVES: Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing...
2016: American Journal of Managed Care
Deepashree Gupta, Meredith Kirn, Zafar A Jamkhana, Richard Lee, Stewart G Albert, Kimberly M Rollins
BACKGROUND: To assess the efficacy of a unified hyperglycemia and diabetic ketoacidosis (DKA) insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycemic targets and minimizing hypoglycemia. METHODS: An IIP was instituted in medical and surgical intensive care units for post-cardiac surgery (PCS) and other stress hyperglycemia (SH), diabetes hyperglycemia (DH), and DKA. The IIP initiated therapeutic insulin rates at elevated blood glucose (BG), and decreased insulin when target range was achieved...
September 15, 2016: Diabetes & Metabolic Syndrome
Heike A Hildebrandt, Vincent Kreienkamp, Sabine Gent, Philipp Kahlert, Gerd Heusch, Petra Kleinbongard
Although remote ischemic pre-conditioning (RIPC) reduced infarct size in animal experiments and proof-of-concept clinical trials, recent phase III trials failed to confirm cardioprotection during cardiac surgery. Here, we characterized the kinetic properties of humoral factors that are released after RIPC, as well as the signal transduction pathways that were responsible for cardioprotection in an ex vivo model of global ischemia reperfusion injury. Venous blood from 20 healthy volunteers was collected at baseline and 5 min, 30 min, 1 h, 6 h, and daily from 1 to 7 days after RIPC (3 × 5/5 min upper-limb ischemia/reperfusion)...
January 2016: JACC. Basic to Translational Science
Yabing Zhang, Xiyang Zhang, Dongmei Chi, Siyang Wang, Hua Wei, Hong Yu, Qian Li, Bin Liu
Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury (AKI). However, results of studies evaluating the effect of RIPC on AKI after cardiac surgery have been controversial and contradictory.The aim of this meta-analysis is to examine the association between RIPC and AKI after on-pump cardiac surgery.The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through December 2015.We considered for inclusion all randomized controlled trials that the role of RIPC in reducing AKI and renal replacement therapy (RRT) among patients underwent on-pump cardiac surgical procedures...
September 2016: Medicine (Baltimore)
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