Elective Primary or Secondary Delayed Sternal Closure Improves Outcome in Severely Compromised Patients.

BACKGROUND: Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population. MATERIALS AND METHODS: From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24.73%). Stepwise logistic regression (SLR) showed that patients with lower ejection fraction, dilated right ventricle, and severe pulmonary hypertension were more likely to need DSC. Patients were divided in two groups: group A (n = 17), when the sternum was reopened before any hemodynamic collapse, or was never closed, and group B (n = 16), when the sternum was reopened after hemodynamic collapse. RESULTS: Inhospital mortality was 39% (n = 13), 18% in group A and 62% in group B (p < 0.0001). In 28 patients where the sternum was reopened, cardiac index increased from 1.7 (1.6, 1.9) L/m2 to 2.8 (2.4, 3) L/m2, p < 0.0001. The sternum was closed in 28 patients (85%), 94% in group A and 75% in group B (p = 0.13), after a median of 4 (2.5) days. SLR showed that only group B (p < 0.0001) was a risk factor for early death. Two-year survival was 48 ± 9%, higher in group A (71 ± 13) than in group B (25 ± 11), p < 0.0001. Cox's analysis showed that group B (p < 0.0001) and redo (p < 0.0001) were risk factors for lower survival. CONCLUSION: Elective DSC represents a useful strategy in severely compromised patients, entailing an improvement of hemodynamics and a higher survival.

A novel weighted family of probability distributions with applications to world natural gas, oil, and gold reserves.

Recent innovations have focused on the creation of new families that extend well-known distributions while providing a huge amount of practical flexibility for data modeling. Weighted distributions offer an effective approach for addressing model building and data interpretation problems. The main objective of this work is to provide a novel family based on a weighted generator called the length-biased truncated Lomax-generated (LBTLo-G) family. Discussions are held about the characteristics of the LBTLo-G family, including expressions for the probability density function, moments, and incomplete moments. In addition, different measures of uncertainty are determined. We provide four new sub-distributions and investigated their functionalities. Subsequently, a statistical analysis is given. The LBTLo-G family's parameter estimation is carried out using the maximum likelihood technique on the basis of full and censored samples. Simulation research is conducted to determine the parameters of the LBTLo Weibull (LBTLoW) distribution. Four genuine data sets are considered to illustrate the fitting behavior of the LBTLoW distribution. In each case, the application outcomes demonstrate that the LBTLoW distribution can, in fact, fit the data more accurately than other rival distributions.

Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain.

BACKGROUND: Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use. PATIENTS AND METHODS: Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure. RESULTS: The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time. CONCLUSION: The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival.