The Effect of the Knowledge, Skills, and Attitudes from Nurse Training Using In Situ Simulation in an Intensive Care Unit.

BACKGROUND: In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. METHODS: This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. RESULTS: The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. CONCLUSIONS: In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field.

Underestimated Subsequent Sensorineural Hearing Loss after Septicemia.

Background and Objectives: Hearing loss after septicemia has been found in mice; the long-term risk increased 50-fold in young adults in a previous study. Hearing loss after septicemia has not received much attention. The aim of this study was to assess the relationship between septicemia and subsequent hearing loss. Materials and Methods: Inpatient data were obtained from the Taiwan Insurance Database. We defined patients with sensorineural hearing loss and excluded patients under 18 years of age. Patients without hearing loss were selected as controls at a frequency of 1:5. The date of admission was defined as the date of diagnosis. Comorbidities in the 3 years preceding the date of diagnosis were retrieved retrospectively. Associations with hearing loss were established by multiple logistic regression and forward stepwise selection. Results: The odds ratio (OR) for the association between sepsis and hearing loss was 3.052 (95% CI: 1.583-5.884). Autoimmune disease (OR: 5.828 (95% CI: 1.906-17.816)), brain injury (OR: 2.264 (95% CI: 1.212-4.229)) and ischemic stroke (OR: 1.47 (95% CI: 1.087-1.988)) were associated with hearing loss. Conclusions: Our study shows that hearing loss occurred after septicemia. Apoptosis caused by sepsis and ischemia can lead to hair cell damage, leading to hearing loss. Clinicians should be aware of possible subsequent complications of septicemia and provide appropriate treatment and prevention strategies for complications.

Anti-Bacterial and Anti-Fouling Capabilities of Poly(3,4-Ethylenedioxythiophene) Derivative Nanohybrid Coatings on SUS316L Stainless Steel by Electrochemical Polymerization.

We have successfully fabricated poly(3,4-ethylenedioxythiophene) (PEDOT) derivative nanohybrid coatings on flexible SUS316L stainless steel by electrochemical polymerization, which can offer anti-fouling and anti-bacterial capabilities. PEDOT derivative nanohybrids were prepared from polystyrene sulfonates (PSS) and graphene oxide (GO) incorporated into a conducting polymer of PEDOT. Additionally, the negative charge of the PEDOT/GO substrate was further modified by poly-diallyldimethylammonium chloride (PDDA) to form a positively charged surface. These PEDOT derivative nanohybrid coatings could provide a straightforward means of controlling the surface energy, roughness, and charges with the addition of various derivatives in the electrochemical polymerization and electrostatically absorbed process. The characteristics of the PEDOT derivative nanohybrid coatings were evaluated by Raman spectroscopy, scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), water contact angle, and surface potential (zeta potential). The results show that PEDOT/PSS and PEDOT/GO nanohybrid coatings exhibit excellent anti-fouling capability. Only 0.1% of bacteria can be adhered on the surface due to the lower surface roughness and negative charge surface by PEDOT/PSS and PEDOT/GO modification. Furthermore, the anti-bacterial capability (7 mm of inhibition zone) was observed after adding PDDA on the PEDOT/GO substrates, suggesting that the positive charge of the PEDOT/GO/PDDA substrate can effectively kill bacteria (Staphylococcus aureus). Given their anti-fouling and anti-bacterial capabilities, PEDOT derivative nanohybrid coatings have the potential to be applied to biomedical devices such as cardiovascular stents and surgical apparatus.

Magnetic Graphene-Based Sheets for Bacteria Capture and Destruction Using a High-Frequency Magnetic Field.

Magnetic reduced graphene oxide (MRGO) sheets were prepared by embedding Fe3O4 nanoparticles on polyvinylpyrrolidone (PVP) and poly(diallyldimethylammonium chloride) (PDDA)-modified graphene oxide (GO) sheets for bacteria capture and destruction under a high-frequency magnetic field (HFMF). The characteristics of MRGO sheets were evaluated systematically by transmission electron microscopy (TEM), scanning electron microscopy (SEM), zeta potential measurement, X-ray diffraction (XRD), vibrating sample magnetometry (VSM), and X-ray photoelectron spectroscopy (XPS). TEM observation revealed that magnetic nanoparticles (8-10 nm) were dispersed on MRGO sheets. VSM measurements confirmed the superparamagnetic characteristics of the MRGO sheets. Under HFMF exposure, the temperature of MRGO sheets increased from 25 to 42 °C. Furthermore, we investigated the capability of MRGO sheets to capture and destroy bacteria (Staphylococcus aureus). The results show that MRGO sheets could capture bacteria and kill them through an HFMF, showing a great potential in magnetic separation and antibacterial application.

Spontaneously Micropatterned Silk/Gelatin Scaffolds with Topographical, Biological, and Electrical Stimuli for Neuronal Regulation.

Effective integration of stimulation and direction in bionic scaffolds by materials and microstructure design has been the focus in the advancement of nerve regeneration. Hydrogels are the most promising biomimicked materials used in developing nerve grafts, but the highly hydrated networks limit the fabrication of hydrogel materials into complex biomedical devices. Herein, facile lithography-free and spontaneously micropatterned techniques were used to fabricate a smart protein hydrogel-based scaffold, which carried topographical, electrical, and chemical induction for neural regulation. The synthesized tissue-mimicked silk-gelatin (SG)/polylactic acid bilayer system can self-form three-dimensional ordered corrugation micropatterns with well-defined dimensions (wavelength, λ) based on the stress-induced topography. Through magnetically and topographically guided deposition of the synthesized nerve growth factor-incorporated Fe3O4-graphene nanoparticles (GFPNs), a biologically and electrically conductive cell passage with one-dimensional directionality was constructed to allow for a controllable constrained geometric effect on neuronal adhesion, differentiation, and neurite orientation. Particularly, the SG with corrugation patterns of λ ≈ 30 µm resulted in the optimal cell adhesion and differentiation in response to the pattern guidance. Furthermore, the additional electrical stimulation applied on GFPN-deposited SG resulted in a 1.5-fold increase in the neurite elongation by day 7, finally leading to the neuronal connection by day 21. Such a hydrogel device with synergistic effects of physical and chemical enhancement on neuronal activity provides an expectable opportunity in the development of next-generation nerve conduits.

Electrochemical Polymerization of PEDOT-Graphene Oxide-Heparin Composite Coating for Anti-fouling and Anti-clotting of Cardiovascular Stents.

In this study, a novel hemocompatible coating on stainless steel substrates was prepared by electrochemically copolymerizing 3,4-ethylenedioxythiophene (EDOT) with graphene oxide (GO), polystyrene sulfonate (PSS), or heparin (HEP) on SUS316L stainless steel, producing an anti-fouling (anti-protein adsorption and anti-platelet adhesion) surface to avoid the restenosis of blood vessels. The negative charges of GO, PSS, and HEP repel negatively charged proteins and platelets to achieve anti-fouling and anti-clotting. The results show that the anti-fouling capability of the poly(3,4-ethylenedioxythiophene) (PEDOT)/PSS coating is similar to that of the PEDOT/HEP coating. The anti-fouling capability of PEDOT/GO is higher than those of PEDOT/HEP and PEDOT/PSS. The reason for this is that GO exhibits negatively charged functional groups (COO-). The highest anti-fouling capability was found with the PEDOT/GO/HEP coating, indicating that electrochemical copolymerization of PEDOT with GO and HEP enhances the anti-fouling capability. Furthermore, the biocompatibility of the PEDOT coatings was tested with 3T3 cells for 1-5 days. The results show that all PEDOT composite coatings exhibited biocompatibility. The blood clotting time (APTT) of PEDOT/GO/HEP was prolonged to 225 s, much longer than the 40 s of pristine SUS316L stainless steel (the control), thus greatly improving the anti-blood-clotting capability of cardiovascular stents.

Human recombinant factor VIIa may improve heat intolerance in mice by attenuating hypothalamic neuronal apoptosis and damage.

Intolerance to heat exposure is believed to be associated with hypothalamo-pituitary-adrenocortical (HPA) axis impairment [reflected by decreases in blood concentrations of both adrenocorticotrophic-hormone (ACTH) and corticosterone]. The purpose of this study was to determine the effect of human recombinant factor VIIa (rfVIIa) on heat intolerance, HPA axis impairment, and hypothalamic inflammation, ischemic and oxidative damage, and apoptosis in mice under heat stress. Immediately after heat stress (41.2 °C for 1 h), mice were treated with vehicle (1 mL/kg of body weight) or rfVIIa (65-270 µg/kg of body weight) and then returned to room temperature (26 °C). Mice still alive on day 4 of heat exposure were considered survivors. Cellular ischemia markers (e.g., glutamate, lactate-to-pyruvate ratio), oxidative damage markers (e.g., nitric oxide metabolite, hydroxyl radials), and pro-inflammatory cytokines (e.g., interleukin-6, interleukin-1ß, tumor necrosis factor-α) in hypothalamus were determined. In addition, blood concentrations of both ACTH and corticosterone were measured. Hypothalamic cell damage was assessed by determing the neuronal damage scores, whereas the hypothalamic cell apoptosis was determined by assessing the numbers of cells stained with terminal deoxynucleotidyl transferase-mediated αUTP nick-end labeling, caspase-3-positive cells, and platelet endothelial cell adhesion molecula-1-positive cells in hypothalamus. Compared with vehicle-treated heated mice, rfVIIa-treated heated mice had significantly higher fractional survival (8/10 vs 1/10), lesser thermoregulatory deficit (34.1 vs 24.8 °C), lesser extents of ischemic, oxidative, and inflammatory markers in hypothalamus, lesser neuronal damage scores and apoptosis in hypothalamus, and lesser HPA axis impairment. Human recombinant factor VIIa appears to exert a protective effect against heatstroke by attenuating hypothalamic cell apoptosis (due to ischemic, inflammatory, and oxidative damage) in mice.

Inhibition of phosphorylated STAT3 by cucurbitacin I enhances chemoradiosensitivity in medulloblastoma-derived cancer stem cells.

INTRODUCTION: CD133 (PROM1) is a potential marker for cancer stem cells (CSCs), including those found in brain tumors. Recently, medulloblastoma (MB)-derived CD133-positive cells were found to have CSC-like properties and were proposed to be important contributors to tumorigenicity, cancer progression, and chemoradioresistance. However, the biomolecular pathways and therapeutic targets specific to MB-derived CSCs remain unresolved. MATERIALS AND METHODS: In the present study, we isolated CD133(+) cells from MB cell lines and determined that they showed increased tumorigenicity, radioresistance, and higher expression of both embryonic stem cell-related and drug resistance-related genes compared to CD133(-) cells. Bioinformatics analysis suggested that the STAT3 pathway might be important in MB and CD133(+) cells. To evaluate the effects of inhibiting the STAT3 pathway, MB-derived CD133(+/-) cells were treated with the potent STAT3 inhibitor, cucurbitacin I. Treatment with cucurbitacin I significantly suppressed the CSC-like properties and stemness gene signature of MB-derived CD133(+) cells. Furthermore, cucurbitacin I treatment increased the apoptotic sensitivity of MB-derived CD133(+) cells to radiation and chemotherapeutic drugs. Notably, cucurbitacin I demonstrated synergistic effects with ionizing radiation to inhibit tumorigenicity in MB-CD133(+)-inoculated mice. RESULTS: These results indicate that the STAT3 pathway plays a key role in mediating CSC properties in MB-derived CD133(+) cells. Targeting STAT3 with cucurbitacin I may therefore represent a novel therapeutic approach for treating malignant brain tumors.

Enhanced differentiation of three-gene-reprogrammed induced pluripotent stem cells into adipocytes via adenoviral-mediated PGC-1α overexpression.

Induced pluripotent stem cells formed by the introduction of only three factors, Oct4/Sox2/Klf4 (3-gene iPSCs), may provide a safer option for stem cell-based therapy than iPSCs conventionally introduced with four-gene iPSCs. Peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) plays an important role during brown fat development. However, the potential roles of PGC-1α in regulating mitochondrial biogenesis and the differentiation of iPSCs are still unclear. Here, we investigated the effects of adenovirus-mediated PGC-1α overexpression in 3-gene iPSCs. PGC-1α overexpression resulted in increased mitochondrial mass, reactive oxygen species production, and oxygen consumption. Microarray-based bioinformatics showed that the gene expression pattern of PGC-1α-overexpressing 3-gene iPSCs resembled the expression pattern observed in adipocytes. Furthermore, PGC-1α overexpression enhanced adipogenic differentiation and the expression of several brown fat markers, including uncoupling protein-1, cytochrome C, and nuclear respiratory factor-1, whereas it inhibited the expression of the white fat marker uncoupling protein-2. Furthermore, PGC-1α overexpression significantly suppressed osteogenic differentiation. These data demonstrate that PGC-1α directs the differentiation of 3-gene iPSCs into adipocyte-like cells with features of brown fat cells. This may provide a therapeutic strategy for the treatment of mitochondrial disorders and obesity.

A potential for granulocyte-colony stimulating factor for use as a prophylactic agent for heatstroke in rats.

Heatstroke is a form of excessive hyperthermia associated with a systemic inflammatory response that leads to multi-organ dysfunction in which central nervous system disorders predominate. Herein we determined to ascertain whether heat-induced multi-organ dysfunction in rats could be attenuated by granulocyte-colony stimulating factor (G-CSF) preconditioning. Anesthetized rats were divided into 2 major groups and given vehicle solution (isotonic saline, 0.3 ml, subcutaneously) or G-CSF (50-200 µg/kg body weight in 0.3 ml normal saline, subcutaneously) daily and consecutively for 5 days before the start of thermal experiments. They were exposed to an ambient temperature of 43°C for 68 min to induce heatstroke. G-CSF preconditioning significantly prolonged the survival time in heatstroke rats in a dose-related way (82-98 min vs 127-243 min). The non-preconditioning heatstroke animals showed hyperthermia, arterial hypotension, increased serum levels of systemic inflammatory response molecules, increased hypothalamic apoptotic cell numbers as well as neuronal damage scores, and increased serum levels of renal and hepatic dysfunction indicators. These heatstroke syndromes could be significantly reduced by G-CSF preconditioning. Thus our results revealed a potential for G-CSF used as a prophylactic agent for heatstroke in rats.

Aldehyde dehydrogenase 1 is a putative marker for cancer stem cells in head and neck squamous cancer.

Aldehyde dehydrogenase 1 (ALDH1) has been considered to be a marker for cancer stem cells. However, the role of ALDH1 in head and neck squamous cell carcinoma (HNSCC) has yet to be determined. In this study, we isolated ALDH1-positive cells from HNSCC patients and showed that these HNSCC-ALDH1+ cells displayed radioresistance and represented a reservoir for generating tumors. Based on microarray findings, the results of Western blotting and immunofluorescent assays further confirmed that ALDH1+-lineage cells showed evidence of having epithelial-mesenchymal transition (EMT) shifting and endogenously co-expressed Snail. Furthermore, the knockdown of Snail expression significantly decreased the expression of ALDH1, inhibited cancer stem-like properties, and blocked the tumorigenic abilities of CD44+CD24(-)ALDH1+ cells. Finally, in a xenotransplanted tumorigenicity study, we confirmed that the treatment effect of chemoradiotherapy for ALDH1+ could be improved by Snail siRNA. In summary, it is likely that ALDH1 is a specific marker for the cancer stem-like cells of HNSCC.

Formation of TiO(2) nano-network on titanium surface increases the human cell growth.

OBJECTIVES: This study was to improve human cell growth on titanium (Ti) used for dental implants through formation of a nano-network surface oxide layer created by an electrochemical anodization treatment. METHODS: An electrochemical anodization treatment was used to produce a network oxide layer on Ti surface. Surface characterization of the network layer was carried out using thin film X-ray diffractometer and field emission scanning electron microscopy. Human bone marrow mesenchymal stem cells (hMSCs) were made to express green fluorescent protein (GFP) by retroviral transduction. The GFP signal was measured in situ to assess in vitro and in vivo cell growth on Ti surfaces. In vivo experiments on Ti-supported cell growth were carried out on the back skin of nude mice. Alizarin red staining and immunofluorescent staining were used to observe cell differentiation. RESULTS: A multilayer TiO(2) nano-network was produced rapidly on Ti surface using a simple electrochemical anodization treatment. The TiO(2) nano-network layer on the anodized Ti surfaces significantly improved in vitro and in vivo hMSC growth, as assessed by measurement of GFP fluorescence, relative to hMSC growth on untreated Ti surface. The TiO(2) nano-network layer on the anodized Ti surfaces can also induce the differentiation of hMSCs after 28-day in vivo test. SIGNIFICANCE: The formation of TiO(2) nano-network on the Ti surfaces can increase the hMSC growth in vitro and in vivo.

Enhanced radiosensitivity and radiation-induced apoptosis in glioma CD133-positive cells by knockdown of SirT1 expression.

CD133-expressing glioma cells play a critical role in tumor recovery after treatment and are resistant to radiotherapy. Herein, we demonstrated that glioblastoma-derived CD133-positive cells (GBM-CD133(+)) are capable of self-renewal and express high levels of embryonic stem cell genes and SirT1 compared to GBM-CD133(-) cells. To evaluate the role of SirT1 in GBM-CD133(+), we used a lentiviral vector expressing shRNA to knock-down SirT1 expression (sh-SirT1) in GBM-CD133(+). Silencing of SirT1 significantly enhanced the sensitivity of GBM-CD133(+) to radiation and increased the level of radiation-mediated apoptosis. Importantly, knock-down of SirT1 increased the effectiveness of radiotherapy in the inhibition of tumor growth in nude mice transplanted with GBM-CD133(+). Kaplan-Meier survival analysis indicated that the mean survival rate of GBM-CD133(+) mice treated with radiotherapy was significantly improved by Sh-SirT1 as well. In sum, these results suggest that SirT1 is a potential target for increasing the sensitivity of GBM and glioblastoma-associated cancer stem cells to radiotherapy.

Congenital arteriovenous fistula with aneurysm formation of ulnar artery origin.

Naturally formed arteriovenous fistula (AVF) causing local vascular aneurysm dilatation in the forearm ulnar artery region is rare and is exceedingly uncommon in any age group. Presented is a case of AVF in the left ulnar artery of a 39-year-old man in whom there was no history of trauma; the deformity had been noted since childhood. The AVF had become tortuous and enlarged in size as the patient aged. As a result, aneurysm dilatation formed on the base of the AVF and that of the ulnar artery origin. Despite normal preoperative Allen test result and normal preoperative finger pressure measurement with ulnar artery occlusion, arterial duplex imaging showed that the radial artery was the dominant artery of the left arm; the AVF was resected and the base of the aneurismal dilatation, which was directly related to the ulnar artery, was repaired for the sake of the natural continuity of ulnar blood flow.

The effect of pathophysiology on the outcome of mitral valve repair for mitral regurgitation.

The advantages of mitral valve repair in mitral regurgitation are well established. The aim of this study was to analyze retrospectively the early and mid-term results of primary mitral valve repair. Between January 1995 and August 2001, primary mitral valve repair operations were performed on 112 patients (76 men and 36 women) with mitral regurgitation; the mean age was 59.8 +/- 16.5 years. Mitral valve repair was performed for rheumatic heart disease (13), degenerative disease (60), infective endocarditis (2), ischemic heart disease (26), congenital heart disease (2), and dilated cardiomyopathy (9). The degree of mitral regurgitation was moderate in 28 patients, moderately severe in 17 patients, and severe in 67 patients, as determined by echocardiography. Left ventricular ejection fraction (mean 41.2% +/- 13.5%) was measured by radionuclide ventriculography. Fifty percent of patients underwent additional procedures (e.g., coronary artery bypass grafting). The mortality rate was 8.9% (10/112) for hospitalized patients, 19.2% (5/26) for ischemic disease, and 5% (3/60) for degenerative disease. Follow-up duration ranged from 0.37 to 84.03 months. All survivors were evaluated with serial echocardiography. At the final follow-up echocardiography of 94 patients without reoperation and 6 patients at the time of reoperation, 84% had no or mild mitral regurgitation. The survival rate at 5 years was 92.68 +/- 3.57% for degenerative disease and 44.47% +/- 10.89% for ischemic disease. The risk of infective endocarditis (1.78%), thromboembolism (1.78%), and anticoagulant-related complications (0.8%) was very low during the follow-up period. The pathophysiological mechanism resulting in mitral regurgitation was the most important determinant of outcome after mitral valve repair. Excellent results were achieved with mitral valve repair for degenerative disease. Because of low morbidity and acceptable mortality, we strongly recommend mitral valve repair for mitral regurgitation due to degenerative disease.

Lessons learned from the endovascular treatment of abdominal aortic aneurysm and a preliminary experience of our center.

BACKGROUND: The development of technical approaches for endovascular abdominal aortic aneurysm (AAA) repair during the last decade was briefly reviewed. The role of endovascular AAA repair as a new reliable method of treatment in high-risk patients was evaluated in both the major studies reported and a preliminary result of our center. METHODS: General criteria for the selection and exclusion of high-risk patients were summarized. Six patients (mean age: 72 years) with complex infrarenal AAA underwent endovascular aneurysm repair using the bifurcated stent graft system. Routine follow-up examination included computed tomography performed periodically from the post-operative month up to one year. Patients suspected of endoleak underwent angiography and further endovascular treatment. RESULTS: Successful deployment of the endograft and exclusion of the aneurysm was achieved in all six patients (100%) in our preliminary series. None of our patients required conversion to open aneurysmal repair. Comorbidity was an important factor in the outcome of aneurysm repair in high-risk patients, with cardiovascular disease and chronic obstructive pulmonary disease being the major comorbid conditions. Cardiac events were the most common complications, followed by transient renal failure, wound infection and endoleaks, which were corrected with endovascular treatment. CONCLUSIONS: The long-term results and efficacy of endovascular repair of infrarenal AAA remain to be demonstrated, but the procedure is believed to provide a safe and effective alternative treatment for high-risk patients suffering from AAA.

Surgical techniques for emergent repair of post-infarction ventricular septal defect: compare endocardial patch and infarct exclusion method with traditional method.

BACKGROUND: The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods. METHODS: From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients. RESULTS: Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1%) had reconstruction in traditional way and 1 (mortality rate = 16.6%) in exclusion way. The complication rate was higher in the traditional group (= 100%, n = 7, p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia. CONCLUSIONS: The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.

Is off-pump coronary artery bypass grafting in multivessel feasible.

BACKGROUND: "Off-pump" coronary artery bypass grafting (OPCABG) became more popular in recent years for its potential advantages of reducing perioperative morbidity related to cardiopulmonary bypass (CPB). We retrospectively analyzed the early results of multivessel OPCABG to compare them with conventional CABG under CPB. METHODS: From April 2000 to Oct 2000, 15 patients received multivessel OPCABG (group A). CTS or Octopus II stabilizer was used with coronary anastomosis. "Auto-perfusion system" was used at late stage of our series for myocardial protection in the procedure. At the same time, patients who received primary isolated CABG under CPB were compared as control (group B). RESULTS: There was no operative mortality or major morbidity in the group of multivessel OPCABG. Two patients who failed multivessel OPCABG due to hemodynamics compromise were converted to conventional CABG under CPB uneventfully. The amount of operative blood loss and donor blood transfusion, the duration of postoperative mechanical ventilation support, the mean intensive care unit stay and postoperative hospital stay were less in group A. CONCLUSIONS: Multivessel OPCABG is feasible in surgical techniques in selected patient. It is associated with minimal operative mortality and morbidity partly because of obviating the adverse effect of CPB. Prospective study with long-term follow-up is needed to better define the role of OPCABG.

Perioperative result of carotid endarterectomies with venous patch angioplasty.

BACKGROUND: Carotid endarterectomy (CEA) is an effective treatment of carotid stenosis to reduce the risk of stroke. The purpose of the current study is to investigate the result of surgical treatment of carotid stenosis in Taipei Veterans General Hospital. METHODS: The medical records of 103 patients receiving 113 CEA with or without patch angioplasty in our service between January 1993 and July 1999 were reviewed retrospectively. The clinical and operative variables were collected for analysis. According to the method of carotid arteriotomy closure, all operations were categorized into 3 groups: 76 CEA with venous patch angioplasty, 27 CEA with synthetic angioplasty and 10 primary closure without patch angioplasty. The outcomes of CEA among 3 groups were compared. RESULTS: There was no significant difference of patient characteristics between 3 groups. Four patients died in the same admission. The incidence of hospital mortality was 0% for venous patch group (p = 0.01), 11.1% for synthetic patch group and 10% for primary closure group. There were 5 perioperative complications including 3 with ipsilateral stroke and 2 with wound hematoma. The incidence of perioperative complication rate was 2.6% for venous patch group, 7.4% for synthetic patch group and 10% for primary closure group (p = 0.87). The incidence of perioperative CVA was 1.3% for venous patch group, 3.7% for synthetic patch group, 10% for primary closure group (p = 0.43). CONCLUSIONS: Our study showed that CEA could be performed with low risk and that venous angioplasty carried lower hospital mortality than other methods of carotid arteriotomy closure.

Is combined abdominal aortic aneurysm repair and coronary artery bypass grafting feasible?

BACKGROUND: Significant coronary artery disease requiring coronary artery bypass grafting (CABG) may co-exist with large abdominal aortic aneurysm (AAA) in some patients. We reviewed our experience in either staged or simultaneous operation. METHODS: The records of all patients receiving both CABG and AAA repairs in recent 7 years were retrospectively reviewed. The patient demographics, severity of coronary disease, AAA size, duration of staged procedures, perioperative morbidity and mortality rates as well as the hospital cost were analyzed. RESULTS: From June 1993 to Sept 2000, totally 14 patients received both CABG and AAA repair, including 6 patients for simultaneous operation (group A, 42.8%) and 8 for staged operation (group B, 57.2%) with CABG first. Patients in the group A were younger and with larger AAA. There was neither operative mortality in both group nor interprocedure AAA rupture in group B. Total postoperative hospital stay and hospital cost were significantly decreased in group A than in group B rehospitalized patients. CONCLUSIONS: Simultaneous CABG and AAA repair is feasible in surgical technique. In those younger patients with larger AAA, combined surgery could be performed as safely as staged procedures.