Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair.

INTRODUCTION: Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. MATERIALS AND METHODS: All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. RESULTS: Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1-5.5, vs 5.4, IQR 2.2-8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180-227, vs 165 minutes (IQR 145-189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121-150 minutes) vs 111 minutes (IQR 91-137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. CONCLUSIONS: The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.

Bleaching susceptibility and mortality of corals are determined by fine-scale differences in symbiont type.

Coral bleaching has been identified as one of the major contributors to coral reef decline, and the occurrence of different symbionts determined by broad genetic groupings (clades A-H) is commonly used to explain thermal responses of reef-building corals. By using Stylophora pistillata as a model, we monitored individual tagged colonies in situ over a two-year period and show that fine level genetic variability within clade C is correlated to differences in bleaching susceptibility. Based on denaturing gradient gel electrophoresis of the internal transcribed spacer region 2, visual bleaching assessments, symbiont densities, host protein, and pulse amplitude modulated fluorometry, we show that subcladal types C78 and C8/a are more thermally tolerant than C79 and C35/a, which suffered significant bleaching and postbleaching mortality. Although additional symbiont types were detected during bleaching in colonies harboring types C79 and C35/a, all colonies reverted back to their original symbionts postbleaching. Most importantly, the data propose that the differential mortality of hosts harboring thermally sensitive versus resistant symbionts rather than symbiont shuffling/switching within a single host is responsible for the observed symbiont composition changes of coral communities after bleaching. This study therefore highlights that the use of broad cladal designations may not be suitable to describe differences in bleaching susceptibility, and that differential mortality results in a loss of both symbiont and host genetic diversity and therefore represents an important mechanism in explaining how coral reef communities may respond to changing conditions.

Retention characteristics of a new butylimidazolium-based stationary phase.

A new HPLC stationary phase has been synthesized based on the ionic liquid n-butylimidazolium bromide. Imidazolium was covalently immobilized on a silica substrate through an n-alkyl tether and the retention characteristics of the resulting stationary phase were evaluated systematically. Using 28 small aromatic test solutes and reversed phase conditions, the linear solvation energy relationship approach was successfully used to characterize this new phase. The retention characteristics of the test solutes show remarkable similarity with phenyl stationary phases, despite the presence of a positive charge on the new imidazolium phase. Operated in the reversed phase mode, this new stationary phase shows considerable promise for the separation of neutral solutes and points to the potential for a truly multi-modal stationary phase.

Non-coherent light for photodynamic therapy of superficial tumours in animals.

Cultured 9L cells were incubated with varying concentrations of pheophorbide-a-hexyl ether (HPPH) and then exposed to 665-nm red light from a non-coherent light source or a dye laser. Cell death was produced by both light sources, with the non-coherent light being most effective at the highest HPPH concentrations. To assess the feasibility of using the non-coherent light source for clinical photodynamic therapy (PDT), four dogs and three cats presenting with spontaneous superficial tumours were injected intravenously with 0.15 mg kg(-1) of HPPH, 1 h before their tumours were irradiated with 665-nm non-coherent light (50 mW cm(-2), 100 J cm(-2)). Of the nine tumours treated, there were eight complete responses, all occurring in animals with squamous cell carcinoma. After 68 weeks of follow-up, the median initial disease-free interval had not been reached. These data suggest that non-coherent light sources may be efficacious for photodynamic therapy of spontaneous superficial tumours in animals, representing a cost-effective alternative to medical lasers in both veterinary and human oncology.

Preclinical evaluation of 5-aminolevulinic acid-based photodynamic therapy for canine transitional cell carcinoma.

As a prelude to photodynamic therapy, 5-aminolevulinic acid (ALA) was given orally to healthy dogs. ALA-induced protoporphyrin IX (PpIX) fluorescence significantly increased in the mucosa of the urinary bladder in an ALA dose-dependent fashion. Vomiting occurred after ALA administration in 70% of the dogs but did not affect PpIX fluorescence. ALA-based photodynamic therapy (PDT) of the urinary bladder in healthy dogs caused only submucosal oedema within the bladder wall. No haematologic or serum biochemistry abnormalities were observed after ALA administration. Microscopic haematuria was observed in all the dogs after PDT but was mild and self limiting. ALA-based PDT was administered to six dogs with transitional cell carcinoma (TCC) of the lower urinary tract. ALA-based PDT resulted in tumour progression-free intervals from 4 to 34 weeks in five dogs; one dog with pre-existing hydronephrosis died shortly after PDT. Dogs with TCC represent an outbred, spontaneous, tumour model for developing PDT protocols for humans with bladder cancer.

Spectroelectrochemical sensing based on multimode selectivity simultaneously achievable in a single device. 5. Simulation of sensor response for different excitation potential waveforms.

The simulation of the optical response in spectroelectrochemical sensing has been investigated. The sensor consists of a sensing film coated on an optically transparent electrode (OTE). The mode of detection is attenuated total reflection. Only species that partition into the sensing film, undergo electrochemistry at the potentials applied to the OTE, and have changes in their absorbance at the wavelength of light propagated within the glass substrate of the OTE can be sensed. A fundamental question arises regarding the excitation potential waveforms employed to initiate the electrochemical changes observed. Historically, selection has been based solely upon the effectiveness of the waveform to quickly electrolyze any analyte observable by the optical detection method employed. In this report, additional requirements by which the waveform should be selected for use in a remote sensing configuration are discussed. The effectiveness of explicit finite difference simulation as a tool for investigating the applicability of three different excitation potential waveforms (square, triangle, sinusoid) is demonstrated. The simulated response is compared to experimental results obtained from a prototype sensing platform consisting of an indium tin oxide OTE coated with a cation-selective, sol-gel-derived Nafion composite film designed for the detection of a model analyte, tris(2,2'-bipyridyl)ruthenium(II) chloride. Using a diffusion coefficient determined from experimental data (5.8 x 10(-11) cm2 s for 5 x 10(-6) M Ru(bipy)3(2+)), the simulator program was able to accurately predict the magnitude of the absorbance change for each potential waveform (0.497 for square, 0.403 for triangular, and 0.421 for sinusoid), but underestimated the number of cycles required to approach steady state. The simulator program predicted 2 (square), 3 (triangle), and 5 cycles (sinusoid), while 5 (square), 15 (triangle), and 10 (sinusoid) cycles were observed experimentally.

Informational orthogonality of two-dimensional chromatographic separations.

A qualitative informational similarity technique has been used to describe the informational orthogonality of projected two-dimensional (2-D) chromatographic separations of complex mixtures from their one-dimensional 1-D separations. The reversed-phase liquid chromatography (RPLC), supercritical fluid chromatography (SFC), gas-liquid chromatography (GLC), and micellar electrokinetic capillary chromatography (MECC) retention behavior of up to 46 solutes of varying molecular properties was studied by 2-D range-scaled retention time plots and information entropy calculations. One hundred five combinations of technique/stationary phase pairs were used to simulate the 2-D chromatographic analyses. The informational entropy of one and two dimensions, the mutual information, the synentropy or "cross information", and the informational similarity were calculated to describe the informational orthogonality. In addition, pattern descriptors were used to qualitatively describe the 2-D peak distribution. With the solutes tested, informational orthogonality, zero informational similarity, was observed with MECC-SDS/SFC-C1, MECC-SDS/SFC-Carbowax, MECC-TTAB/SFC-Carbowax, HPLC-C18/GLC-DB-5, HPLC-PBD/SFC-phenyl, SFC-Carbowax/GLC-DB5, and HPLC-phenyl/SFC-phenyl 2-D chromatographic systems. Conversely, with the solutes tested, informational nonorthogonal behavior described by range-scaled retention time plots to moderate to severe band overlap and data clustering was observed with 2-D chromatographic systems with high informational similarity and moderate to high degrees of synentropy. These results should prove useful for predicting complementary 2-D techniques as well as for choosing a second separation technique for confirmation of separation or peak purity.