Clinical outcome of a branch-first approach with a novel continuous whole-brain perfusion strategy for total arch surgery.

BACKGROUND: Cerebral protection strategies have been investigated since the introduction of aortic arch surgery and have been modified over the centuries. However, the cerebral protective effects of unilateral and bilateral antegrade cerebral perfusion are similar, with opportunities for further improvement. METHODS: A total of 30 patients who underwent total arch surgery were enrolled in this study. Patients were assigned to the novel continuous whole-brain or unilateral antegrade cerebral perfusion group according to the cerebral perfusion technique used. Preoperative clinical data and 1-year postoperative follow-up data were collected and analyzed. RESULTS: There were no significant differences between the two groups in terms of the incidence of permanent neurological deficit, mortality, or therapeutic efficacy. However, the incidence of temporary neurological dysfunction in the novel whole-brain perfusion group was significantly lower than that in the unilateral antegrade cerebral perfusion group. CONCLUSIONS: In this study, the branch-first approach with a novel whole-brain perfusion strategy had no obvious disadvantages compared with unilateral antegrade cerebral perfusion in terms of cerebral protection and surgical safety. These findings suggest that this new technique is feasible and has application value for total arch surgery.

A meta-analysis examined the effect of topical vancomycin application in decreasing sternal wound infections post cardiac surgery.

To assess the impact of topical vancomycin (TV) application in decreasing sternal wound infections (SWIs) post cardiac surgery (CS), we lead a meta-analysis. Twenty-three thousand seven hundred and forty five participants had CS at the outset of the investigations, according to a thorough evaluation of the literature done up to November 2022; 8730 of them used TV, while 15 015 were controls. To assess the effectiveness of TV application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with dichotomous technique with a fixed- or random-effect model. The TV had significantly lower SWIs post CS (OR, 0.34; 95% CI, 0.20-0.57; P < .001), and deep SWIs post CS (OR, 0.26; 95% CI, 0.11-0.65; P = .004) compared with control as shown in Figures 2 and 3. Yet, there was no significant difference found amongst TV and control in superficial SWIs post CS (OR, 0.30; 95% CI, 0.07-1.30; P = .011). The TV had significantly lower SWIs, and deep SWIs post CS, and no significant difference was found in superficial SWIs post CS compared with control. The low number of included studies in this meta-analysis for superficial SWIs calls for precaution when analysing the outcomes.

Factors Influencing the Incidence of Pneumonia after Coronary Artery Bypass Grafting.

OBJECTIVE: This study aimed to explore and analyze the factors affecting the incidence of pneumonia after coronary artery bypass grafting (CABG) to provide reference for the prevention of such situation. METHODS: A total of 500 patients who underwent CABG in a hospital were selected. From March 2019 to March 2022, 410 patients without pneumonia and 90 patients with pneumonia were divided into groups A and B. The influencing factors and pathogen composition of postoperative pneumonia were discussed and analyzed. RESULTS: Univariable analysis results showed that age, cardiac function grade, occurrence of smoking, operation time, tracheal intubation time, suspended red-blood-cell transfusion and hospital stay in group B were higher than those in group A. Multivariable logistic analysis results showed that operation time, smoking history, and tracheal intubation time were risk factors for pneumonia after CABG. Among the 90 patients with postoperative pneumonia, 90 had pathogens, 81 had Gram-negative bacteria, 4 had Gram-positive bacteria, and 5 had fungi. CONCLUSIONS: Patients after CABG were more likely to develop pneumonia. Operation time, smoking history, and tracheal intubation time were the risk factors of pneumonia after CABG. Most of these patients had Gram-negative bacteria. Patient intervention based on the influencing factors can effectively prevent the occurrence of postoperative pneumonia.

Molecular evidence of impaired iron metabolism and its association with Parkinson's disease progression.

The aim of the study is to investigate the role of ATP-binding cassette subfamily B member 7 (ABCB7) in correlation with the progression of Parkinson's disease. Initially, the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was used to develop a mouse model of mild and severe forms of Parkinson's disease. Histology, immunohistology, and Western blotting were used to investigate the role of ABCB7 in disease progression. Mice injected with MPTP, at doses of 18 and 30 mg/kg for 10 and 15 consecutive days, respectively, developed mild and severe forms of Parkinson's disease, respectively. Motor dysfunction is accessed through pole test in which, mild and severe forms of Parkinson's disease developed mice takes 1.7 and 3.3 times more time to reach the floor than the control mice. Similarly, in rotarod test, the progression of Parkinson's disease is evident with the progressive loss of motor stability. Histologically, the progression of Parkinson's disease is evident with formation of cell aggregates in mild form; with the formation of more Lewy body structure and tissue hardening in a severe form of Parkinson's disease. Immunohistochemistry showed gradual upregulation of ABCB7 in the cellular cytoplasm in mild stage Parkinson's disease, while significant overexpression of ABCB7 was observed in the severe forms. Western blotting results confirmed 1.6- and 2.9-fold overexpression of ABCB7 in mild and severe forms of Parkinson's disease, respectively. Collectively, the results showed that ABCB7 was present during Parkinson's disease progression. However, upregulation of ABCB7 increased the cytoplasm level of the iron-sulfur complex, which negatively regulated the iron-dependent protein and can be used to determine the progression of Parkinson's disease.