Out-of-plane performance of structurally and energy retrofitted masonry walls: geopolymer versus cement-based textile-reinforced mortar combined with thermal insulation.

This paper examines the out-of-plane performance of masonry walls (representative of infills in reinforced concrete frames) which have been upgraded with an outer skin of integrated structural and an energy retrofitting system. The benefits of such an integrated system are mainly cost-related. Nevertheless, before moving to full-scale applications, additional benefits to the structural performance need to be investigated. In this study, the examined configurations of this composite system comprised either thermal insulation boards bonded directly to the wall followed by layers of textile-reinforced mortar (TRM), or thermal insulation boards bonded in-between two TRM layers. Other than the retrofitting layers configuration, the following parameters were also investigated: a) the binder type (cement-based versus geopolymer-based mortars), and b) the textile type (open mesh glass fibre textile versus basalt fibre textile). The results of this experimental study are discussed in terms of failure modes, post-cracking stiffness and ultimate capacities. Overall, this study highlights the mechanical benefits of the TRM plus thermal insulation system while providing insights on the bond performance between the different materials selected. An important finding is that the integrated system is even more effective than a standard TRM application. Finally, the geopolymer mortar seems to be equivalent in terms of performance to the commercially available cement-based mortars.

The research presented herein deals with novel composite materials for structurally and energy deficient masonry buildings. The paper offers practical insights into integration of standard energy retrofitting and structural retrofitting using innovative and sustainable materials such as geopolymer mortars reinforced with basalt or glass textiles. Geopolymers, which belong to the family of alkali-activated materials (AAM), are innovative inorganic polymers, which can be used as binding materials in construction. Geopolymer-based mortars have the potential to reduce the construction sector's CO ₂ emissions by replacing Ordinary Portland Cement (OPC). Such mortars can be used as binders for open mesh textiles and their production is associated with less CO ₂ emissions compared to OPC-based binders. The use of low-cost basalt and glass textiles allows for good balance between cost and efficiency. Such advanced composite systems combined with thermal insulation and applied to the envelopes of buildings can tackle both structural and energy deficiencies and yet offer a low carbon footprint at a reasonable cost.

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study.

BACKGROUND: Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients. METHODS: In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months). RESULTS: The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity. CONCLUSIONS: Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.

Pericardial patch tracheoplasty for the repair of a long, multisegmental postintubation tracheal damage.

A 64-year-old man was admitted with a postintubation, multisegmental tracheal damage comprising of two stenotic lesions, below and above a tracheotomy. The patient underwent resection of the damaged anterolateral tracheal wall through a combined collar-cuff and median sternotomy incision and tracheoplasty with autologous pericardium around a Silastic T-tube that was fixed to the cricoid cartilage, healthy distal trachea, and the remaining membranous wall. The postoperative period was complicated with a deep sternal wound infection that was successfully treated with vacuum-assisted closure for 2 weeks. Removal of the T-tube 9 months later resulted in a patent and well-functioning airway. Pericardial patch tracheoplasty and T-tube stenting of the repair for several months is a good alternative to extended tracheal resection for the treatment of the rare long, postintubation multisegmental tracheal damage. The pericardial patch is highly resistant to infection and allows the formation of a neotrachea.

Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion.

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

Use of minimized extracorporeal circulation system in noncoronary and valve cardiac surgical procedures-a case series.

The aim of this report is to explore application of minimized cardiopulmonary bypass (CPB) circuits in areas of cardiac surgery other than coronary bypass grafting and aortic valve surgery. We report three cases operated under minimal extracorporeal circulation support. Replacement of the descending thoracic aorta was performed in two patients; one with a descending aortic aneurysm and one with pseudoaneurysm formation after previous coarctation repair. We have also implanted a left ventricular assist device for destination therapy. The minimized extracorporeal circulation system provides optimal circulatory support, while it is associated with reduced postoperative morbidity, minimizing the side effects from the use of CPB. Moreover, when off-pump technique is attempted, it can be used as a standby circuit connected to the patient so as to enhance safety of the procedure. Minimized extracorporeal circulation systems can be used with safety and efficacy in a wide range of cardiac surgeries including descending aorta pathology and assist device implantation.

Intraoperative infusion of S(+)-ketamine enhances post-thoracotomy pain control compared with perioperative parecoxib when used in conjunction with thoracic paravertebral ropivacaine infusion.

OBJECTIVE: The authors explored the use of continuous postoperative subpleural paravertebral ropivacaine alone combined with intraoperative S(+)-ketamine or perioperative parecoxib as a new approach to pain control after major thoracotomy. DESIGN: A randomized study. SETTINGS: A single university hospital. PARTICIPANTS: Eighty patients underwent elective thoracotomy under general anesthesia. METHODS: Study patients were assigned to 1 of 3 groups: group K (n = 27) received intraoperative S(+)-ketamine (0.5 mg/kg as a preincisional bolus followed by a continuous infusion 400 µg/kg/h), group P (n = 27) received perioperative parexocib (40 mg before extubation and 12 hours postoperatively), and group C (n = 26) served as the control group. At the end of surgery, all patients received a subpleural paravertebal infusion of ropivacaine. MEASUREMENTS AND MAIN RESULTS: Pain was assessed by visual analog scores and supplemental morphine consumption with PCA up to 48 hours postoperatively. The duration of stay and postoperative functional parameters also were collected. Compared with ropivacaine alone, S(+)-ketamine significantly reduced pain scores at rest and during movement at 4, 12, 24, and 48 hours postoperatively. Moreover, at 24 and 48 hours, pain was less after S(+)-ketamine compared with parexocib. S(+)-ketamine also reduced morphine needs in comparison to placebo at 4, 12, 24, and 48 hours and in comparison to parexocib at 48 hours after thoracotomy. There were no differences in parameters for lung or bowel function, mobilization time, or ICU and hospital stay. CONCLUSIONS: In patients with thoracotomy, postoperative paravertebral ropivacaine combined with intraoperative S(+)-ketamine provided better early postoperative pain relief than ropivacaine and perioperative parexocib or ropivacaine alone.

Environmental and Psychophysical Heat Stress in Adolescent Tennis Athletes.

PURPOSE: We investigated the environmental conditions in which all outdoor International Tennis Federation (ITF) junior tournaments (athlete ages: <18 y) were held during 2010-2019. Thereafter, we performed a crossover trial (ClinicalTrials.gov: NCT04197375) assessing the efficacy of head-neck precooling for mitigating the heat-induced psychophysical and performance impacts on junior athletes during tennis match play. METHODS: ITF junior tournament information was collected. We identified meteorological data from nearby (13.6 [20.3] km) weather stations for 3056 (76%) tournaments. RESULTS: Overall, 30.1% of tournaments were held in hot (25°C-30°C wet-bulb globe temperature [WBGT]; 25.9%), very hot (30°C-35°C WBGT; 4.1%), or extremely hot (>35°C WBGT; 0.1%) conditions. Thereafter, 8 acclimatized male junior tennis athletes (age = 16.0 [0.9] y; height = 1.82 [0.04] m; weight = 71.3 [11.1] kg) were evaluated during 2 matches: one with head-neck precooling (27.7°C [2.2°C] WBGT) and one without (27.9°C [1.8°C] WBGT). Head-neck precooling reduced athletes' core temperature from 36.9°C (0.2°C) to 36.4°C (0.2°C) (P = .001; d = 2.4), an effect reduced by warm-up. Head-neck precooling reduced skin temperature (by 0.3°C [1.3°C]) for the majority of the match and led to improved (P < .05) perceived exertion (by 13%), thermal comfort (by 14%), and thermal sensation (by 15%). Muscle temperature, heart rate, body weight, and urine specific gravity remained unaffected (P ≥ .05; d < 0.2). Small or moderate improvements were observed in most performance parameters assessed (d = 0.20-0.79). CONCLUSIONS: Thirty percent of the last decade's ITF junior tournaments were held in hot, very hot, or extremely hot conditions (25°C-36°C WBGT). In such conditions, head-neck precooling may somewhat lessen the physiological and perceptual heat strain and lead to small to moderate improvements in the match-play performance of adolescent athletes.

Minimal extracorporeal circulation circuit standby for "off-pump" left ventricular assist device implantation.

We propose, as an addition to the off-pump technique for implantation of an axial flow left ventricular assist device, the use of a minimal extracorporeal circuit for circulatory support, in the setting of hemodynamic instability during implantation. Thus, the use of conventional cardiopulmonary bypass could be avoided. This set-up provides simplicity and effectiveness and enhanced safety of the off-pump implantation while it may offer adequate circulatory support if required.

Non-pulsatile circulation with axial-flow left ventricular assist device preserves neurocognitive function.

Concerns about the potential impact of the non-pulsatile circulation pattern generated by the new generation axial-flow left ventricular assist devices on neurocognitive function led us to evaluate a patient in whom a Jarvik 2000 pump was implanted. We assessed the patient's baseline neurocognitive function preoperatively as well as at 1-month and 6-month follow-up, using a comprehensive battery of neuropsychological tests. A slight improvement in circumscribed neurocognitive domains was noted, with no evidence of further decline at the end of a 6-month follow-up period.

Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures.

During the last decade, minimized extracorporeal circulation (MECC) systems have shown beneficial effects to the patients over the conventional cardiopulmonary bypass (CECC) circuits. This is a prospective randomized study of 99 patients who underwent coronary artery bypass grafting (CABG) surgery, evaluating the postoperative haematological effects of these systems. Less haemodilution (p=0.001) and markedly less haemolysis (p<0.001), as well as better preservation of the coagulation system integrity (p=0.01), favouring the MECC group, was found. As a clinical result, less bank blood requirements were noted and a quicker recovery, as far as mechanical ventilation support and ICU stay are concerned, was evident with the use of MECC systems. As a conclusion, minimized extracorporeal circulation systems may attenuate the adverse effects of conventional circuits on the haematological profile of patients undergoing CABG surgery.

Management of left ventricular free wall rupture under extracorporeal membrane oxygenation support.

This is a case report of a patient with left ventricular free wall rupture after acute myocardial infarction that was managed successfully with the use of an extracorporeal membrane oxygenation circuit for resuscitation, surgical repair and postoperative circulatory support. Conversion to conventional cardiopulmonary bypass for surgical repair was avoided. Decompression of the left ventricle during the postoperative period promotes myocardial recovery and leads to improved fixation of surgical repair.

A case of severe sinus bradycardia complicating anicteric leptospirosis.

A potential complication of leptospirosis is cardiovascular involvement. Electrocardiographic abnormalities are frequent. Leptospirosis has been reported to be one of the infectious causes of relative bradycardia, but severe absolute sinus bradycardia has been rarely described as a potential electrocardiographic alteration. We present a case of marked sinus bradycardia (35 bpm) lasting for 4 days in a patient with anicteric leptospirosis and relative bradycardia on admission. Heart rate resolved spontaneously after control of infection by appropriate antibiotic therapy. This case points toward the need for close monitoring of vital signs and electrocardiogram in leptospirosis, especially when relative bradycardia is present on admission.

Primary Sjögren syndrome complicated by autoimmune hemolytic anemia and pure red cell aplasia.

Patients with primary Sjögren syndrome frequently present hematologic abnormalities, consisting mainly of immune cytopenias. Pure red cell aplasia is a very rare complication of primary Sjögren syndrome. This is the first report in the literature describing the development of pure red cell aplasia combined with autoimmune hemolytic anemia in a 74-year-old woman with primary Sjögren syndrome. In our patient, despite administration of diverse therapeutic schemes, such as corticosteroids, immunomodulating agents (intravenous immune globulin), immunosuppressive drugs (cyclophosphamide), and novel treatment options (monoclonal antibody directed against the CD20 antigen), no response was achieved. The present case suggests that the possibility of comorbid connective tissue disease should be a diagnostic consideration in patients with acquired pure red cell aplasia and autoimmune hemolytic anemia. Although most of the hematologic abnormalities that occur in primary Sjögren syndrome are not clinically significant, serious and difficult-to-treat hematologic complications may also occur.

Granulomas Formation in Lymph Nodes, Liver and Spleen in Adult-Onset Still's Disease: A Case Report.

Tissue granulomas formation in adult-onset Still's disease (AOSD) is extremely rare. We describe a case of AOSD associated with formation of granulomatous lesions in lymph nodes, liver and presumably spleen. The high dose steroid-dependent nature of our patient's illness, characterized by disease relapses when methylprednisolone dose was reduced below 10 mg/d, was overwhelmed with institution of anakinra (100 mg/d). The histologic finding of granulomas formation in lymph nodes, liver or spleen should not deter the consideration of AOSD as a potential diagnosis in a compatible clinical context; however, other more common etiologies of tissue granulomas formation should be first excluded.

Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The question whether use of minimal extracorporeal circulation (MECC) influences patients' outcome remains unanswered. We performed a systemic review of the literature and a meta-analysis of randomized controlled trials to evaluate the impact of MECC compared to conventional extracorporeal circulation (CECC) on mortality and major adverse cardiovascular events in patients undergoing heart surgery. METHODS: We independently conducted a systemic review of English and non-English articles using Medline, Embase and Cochrane database. Random allocation to treatment with a minimum of 40 patients in both groups was considered mandatory for inclusion in the meta-analysis. Primary outcomes were operative mortality and major adverse cardiac and cerebrovascular events comprising death before discharge, myocardial infarction and neurologic damage. RESULTS: We included 24 studies comparing MECC vs. CECC with a total of 2770 patients. Use of MECC was associated with a significant decrease in mortality (0.5% vs. 1.7%, P=0.02), in the risk of postoperative myocardial infarction (1.0% vs. 3.8%, P=0.03) and reduced rate of neurologic events (2.3% vs. 4.0%, P=0.08). Additionally, MECC was associated with reduced systemic inflammatory response as measured by polymorphonuclear elastase, hemodilution as calculated by hematocrit drop after procedure, need for red blood cell transfusion, reduced levels of peak troponin release, incidence of low cardiac output syndrome, need for inotropic support, peak creatinine level, occurrence of postoperative atrial fibrillation, duration of mechanical ventilation and intensive care unit stay. CONCLUSIONS: Use of MECC in heart surgery resulted in improved short-term outcome as reflected by reduced mortality and morbidity compared with conventional extracorporeal circulation.

Prevalence of "distressed" personality in patients with coronary artery disease and its correlation with morbidity after coronary surgery.

INTRODUCTION: The "distressed" (Type-D) personality is an emerging risk factor in cardiovascular diseases and is associated with an increased risk of impaired quality of life, morbidity and mortality. The purpose of this study was to explore the prevalence of Type-D personality among patients with coronary artery disease (CAD) and its association with the development of complications following coronary artery bypass grafting surgery. METHODS: A Greek version of the Type-D Personality Scale-14 (DS14), along with the Hospital Anxiety and Depression Scale (HADS) as well as the Ways of Coping Questionnaire (WCQ), were used. A cohort of 323 patients with CAD was examined. RESULTS: The prevalence of Type-D personality among Greek patients with CAD was found to be 18.24%. Type-D patients showed a higher rate of anxiety and depression compared to non Type-D patients. Type-D was also associated with passive coping and negatively correlated with active coping. Regarding postoperative morbidity, type-D patients were at an increased risk of developing postoperative atrial fibrillation, while no significant differences were found in the development of any other complication. CONCLUSIONS: The impact of Type-D personality on health outcomes should be studied further, both in clinical samples and in the general population.