Enzyme functionalized microgels enable precise regulation of dissolved oxygen and anaerobe culture.

Anaerobes are a major constituent of the gut microbiome and profoundly influence the overall health of humans. However, the lack of a simple, cost-effective, and scalable system that mimics the anaerobic conditions of the human gut is hindering research on the gut microbiome and the development of therapeutics. Here, we address this gap by using glucose oxidase and catalase containing gelatin microparticles (GOx-CAT-GMPs) to precisely regulate dissolved oxygen concentration [O2] via GOx-mediated consumption of oxygen. Fluorescence images generated using conjugated polymer afterglow nanoparticles showed that [O2] can be tuned from 257.9 â€‹± â€‹6.2 to 0.0 â€‹± â€‹4.0 â€‹µM using GOx-CAT-GMPs. Moreover, when the obligate anaerobe Bacteroides thetaiotaomicron was inoculated in media containing GOx-CAT-GMPs, bacterial growth under ambient oxygen was comparable to control conditions in an anaerobic chamber (5.4 â€‹× â€‹105 and 8.8 â€‹× â€‹105 colony forming units mL-1, respectively). Finally, incorporating GOx-CAT-GMPs into a bioreactor that permitted continuous radial diffusion of oxygen and glucose generated a gut-mimetic [O2] gradient of 132.4 â€‹± â€‹2.6 â€‹µM in the outer ring of the reactor to 7.9 â€‹± â€‹1.7 â€‹µM at the core. Collectively, these results indicate that GOx-CAT-GMPs are highly effective oxygen-regulating materials. These materials can potentially be leveraged to advance gut microbiome research and fecal microbiota transplantation, particularly in low-resource settings.

It's good to talk! Changes in coronary revascularisation practice in PCI centres without onsite surgical cover and the impact of an angiography video conferencing system.

INTRODUCTION: Percutaneous coronary intervention (PCI) activity has increased more than 6 fold in the last 15 years. Increased demand has been met by PCI centres without on-site surgical facilities. To improve communication between cardiologists and surgeons at a remote centre, we have developed a video conferencing system using standard internet links. The effect of this video data link (VDL) on referral pattern and patient selection for revascularisation was assessed prospectively after introduction of a joint cardiology conference (JCC) using the system. METHODS: Between 1st October 2005 and 31st March 2007, 1346 patients underwent diagnostic coronary angiography (CA). Of these, 114 patients were discussed at a cardiology conference (CC) attended by three consultant cardiologists (pre-VDL). In April 2007, the VDL system was introduced. Between 1st April 2007 and 30th September 2008, 1428 patients underwent diagnostic CA. Of these, 120 patients were discussed at a JCC attended by four consultant cardiologists and two consultant cardiothoracic surgeons (post-VDL). Following case-matching for patient demographics and coronary artery disease (CAD) severity and distribution, we assessed the effect upon management decisions arising from both the pre- and post-VDL JCC meetings. RESULTS: When comparing decision-making outcomes of post-VDL JCC with pre-VDL CC, significantly fewer patients were recommended for PCI (36.8% vs. 17.2% respectively, p = 0.001) and significantly more patients were recommended for surgery (21.1% vs. 48.4% respectively, p < 0.001). There were no significant differences in waiting times for PCI following JCC discussion; however, waiting times for surgical revascularisation were significantly reduced (140.9 ± 71.8 days vs. 99.4 ± 56.6 days respectively, p = 0.045). CONCLUSIONS: The VDL system provides a highly practical method for PCI centres without onsite surgical cover to discuss complex patients requiring coronary revascularisation and significantly increases the number of patients referred for surgical revascularisation rather than PCI.

Early to midterm results with the radial artery in coronary artery bypass grafting following autotransplantation without pharmacological manipulation.

BACKGROUND: In our unit when the radial artery is used as a conduit for myocardial revascularization routine, postoperative calcium-channel blockade is not practised. To preserve the radial artery, it is freed from the surrounding structures together with its venae commitantes and then left, in situ, in circulation, until needed for grafting. We evaluated the early to midterm patency of the radial artery using this strategy in our patients. METHODS: We analysed prospectively collected data on 690 consecutive patients who had isolated primary coronary artery bypass grafting performed between June 1999 and February 2003 with at least one conduit being a radial artery. RESULTS: Radial arteries were used for 851 of 2150 distal anastomoses (39.6%). Median follow-up was 399 days (range 20-1323) and was 99.9% complete. Early mortality was 2.0% (14). Late mortality was 3.0% (21), 12 late deaths were not cardiac related. Nine patients (1.4%) had angiography on clinical grounds a mean of 238 days (range 0-511) postoperatively. Six coronary artery territories were inadequately supplied by their radial artery grafts. Kaplan-Meier event-free survival was 94% and 90% at 1 and 3 years, respectively. CONCLUSIONS: The results of coronary artery bypass grafting using the radial artery in our institution compare favourably with those of other contemporary workers. It is safe to leave the radial artery in situ in the circulation until it is required for grafting. The absence of postoperative pharmacological manipulation of the radial artery does not appear to affect early or midterm outcome.

Verification of a European corn borer (Lepidoptera: Crambidae) loss equation in the major corn production region of the northeastern United States.

Field studies in Pennsylvania and Maryland were conducted during 2000, 2001, and 2002 to test the applicability of published yield loss relationships developed in central Pennsylvania for European corn borer, Ostrinia nubilalis (Hübner), management in warmer, longer season corn, Zea mays L., grain production regions of the northeastern United States. Both isoline hybrids and non-Bt lead hybrids were compared against Bacillus thuringiensis (Bt) hybrids to measure effects of the pest on yield. The European corn borer economic analysis model was used to make site-specific predictions of loss per European corn borer larva for comparison with measured yield loss per larva. Although the model did not predict loss per larva at a field level, it did predict loss at a regional level. The model predicted an overall percentage of yield loss per larva of 2.69+/-0.12% over the region, which was similar to the measured yield loss per larva of 2.66+/-0.59% for isoline hybrids and 3.08+/-0.51% for lead hybrids. The model, on average, provided a good prediction of percentage of yield loss per larva within the climatic zones of 1100-1700 degree-days (DD) (base threshold 12.5 degrees C). Our results suggest that the yield loss relationship developed in Central Pennsylvania, when matched to the timing of third instar second generation European corn borer stalk tunneling is adequate for major corn grain production zones of the northeast United States.

Traumatic avulsion of the suprascapular artery.

Trauma to the subclavian artery and its branches is rare, and usually the result of penetrating injuries. Blunt trauma presents its own peculiar management difficulties, particularly when causing haemorrhage into the thoracic cavity. Cardiothoracic surgeons may be asked to deal with such cases, so an understanding of the anatomy and options for surgical access are essential. We present a case of blunt avulsion of the suprascapular artery resulting in massive haemothorax, a previously unreported injury.

Bipolar illness and the family.

The purpose of this article is to introduce family systems therapy and "family focused treatment" to clinicians working with patients who are diagnosed with bipolar illness. The characteristic traits of healthy family functioning are identified as a template for the clinician to work with the family toward management of bipolar illness. Nathan Ackerman's model of how families handle crises and Carter's and McGoldrick's work with family life cycles provide a guide to understanding family systems work. The focus is on the family system and not just the patient. The issues of bipolar illness are addressed in the family context. Based on the research of Goldstein and Miklowitz and others, treatment of bipolar illness is differentiated from other chronic mental illnesses. Family focused treatment is offered as a model to manage dynamics off bipolar illness. An essential component of therapy with the patient and the family is addressing grief. Interventions and treatment suggestions are offered.

Defense styles and Personality dimensions of research subjects with anxiety and depressive disorders.

We used the Bond Defense Style and Cloninger Tridimensional Personality questionnaires to assess defense styles and personality dimensions in subjects with anxiety and depressive disorders. When measured against a comparison group, maladaptive defense style scores were significantly higher in those with major depression, panic disorder, generalized anxiety disorder, and social phobia, and higher at a trend level in the subjects with obsessive-compulsive disorder and mixed anxiety and depression. However, there were no differences in adaptive defense style scores between the subjects and the comparison group. The harm avoidance personality dimension scores were significantly higher in subjects with both anxiety and depressive disorders than in the comparison group. The harm avoidance scores correlated positively with the maladaptive defense scores, but negatively with the adaptive defense scores. These findings are discussed in terms of severity of illness, level of functioning, and relationships between Axis I and II disorders.

Total anomalous pulmonary venous connection: outcome of surgical correction and management of recurrent venous obstruction.

OBJECTIVE: Total anomalous pulmonary venous connection (TAPVC) can be corrected with low mortality and good outcome. If complicated by pulmonary vein stenosis (PVS), either at presentation or secondary to the repair, the long-term outcome is compromised. We have evaluated an institutional experience with TAPVC, with particular regard to the evolving management of PVS. METHODS: Retrospective analysis of 85 consecutive patients with non-isomeric TAPVC undergoing surgical correction over a 10-year period (1988-1997). In addition, three patients were referred to us with secondary PVS, having had their primary procedure elsewhere. Attention was focused on incidence of PVS, and strategies for management. RESULTS: Median age at first operation was 33 days (range 1-533). Site of drainage was supracardiac (43/88), infracardiac (20/88), cardiac (17/88), and mixed (8/88). On presentation, 35% of patients were ventilated. Early mortality was 7% (6/85), with one late non-cardiac death. 82% of the original patients (70/85) are currently well at a median follow-up of 64 months (range 6-119). The incidence of PVS requiring intervention was 11% (9/85). Median time to PVS was 41 days. In these patients, 18 balloon angioplasties, four endovascular stent placements (in two patients), and a further 23 surgical procedures were performed. Of the nine patients undergoing re-intervention after initial surgery at our institution, five (56%) survived. Two of these have no residual obstruction and right ventricular pressure (RVP) < 50% systemic, two have unilateral obstruction and RVP < 50% systemic, and one has bilateral obstruction and RVP 80% systemic. Of the three patients referred to us with secondary PVS, two are alive and well, and one died early after the first re-operation. CONCLUSIONS: Intrinsic obstruction (endocardial sclerosis or thickening) is associated with worse prognosis and earlier re-intervention than extrinsic (anatomical) obstruction. We advocate an early, aggressive approach to the management of patients with TAPVC, especially in the presence of PVS. This complication is most appropriately managed by a combination of re-operation and repeated balloon dilation.

Polymer heart valves.

Since the introduction of valve replacement surgery, research has aimed at creating a prosthesis that is safe, durable and effective. Neither of the two broad groups of valve currently available is ideal. A prosthetic valve is needed that does not suffer from the known disadvantages of calcification and premature failure (bioprostheses), and thrombogenicity (mechanical valves). Much progress has been made, both in design and materials, and an extensive range of polymer valves has been produced and tested both in vitro and in vivo. Unfortunately, each stage of development has encountered problems preventing successful clinical application. Many design difficulties have been addressed and potentially reduced to acceptable levels, but calcification remains a problem, although much less so than with bioprostheses. New developments in surface modification may hold the key to the elimination of thrombus and calcification, and early in vivo results are promising. It is likely that an effective and safe polymer valve will soon become a third clinical option. The historic aspects behind the development of polymer valves and the current state of research and evaluation are discussed.

Strategies for prophylaxis against prosthetic valve endocarditis: a review article.

Prosthetic valve endocarditis (PVE) is an important cause of the morbidity and mortality associated with heart valve replacement surgery. Once established, it carries a mortality rate that may be as high as 70%. The only treatment for established PVE is rigorous intravenous antimicrobial therapy, although this has extremely limited success. The majority of cases require surgical removal and replacement of the infected prosthesis. At present, the only means of preventing PVE are scrupulous asepsis and prophylactic perioperative antibiotic therapy. If another strategy could be developed that is effective and safe, the incidence of this disastrous complication of valve replacement would be reduced. Such strategies have been extensively investigated from a variety of different perspectives for several years. The understanding of biofilms appears to be pivotal to the development of a successful approach. The historic background to the prevention of PVE, and the current state of research into this area are discussed.

Platelets and cardiopulmonary bypass.

Exposure of blood to an extracorporeal circulation, such as CPB, causes a variety of physiological responses. Haematological derangements are just one of many potential dangers to the patient who undergoes CPB. The paradox of CPB-related problems with the haematological system is that there are some factors tipping the balance towards a bleeding tendency, and others that favour a prothrombotic state. Both of these issues must be dealt with independently to create the safest environment for surgery. It has been demonstrated that platelets play a key role in both haemostatic dysfunction and thrombotic complications of CPB. Much has been achieved, both clinically and in the laboratory, in the understanding of the precise role platelets play in these events, but the exact mechanisms involved have yet to be completely identified. As research progresses, our understanding will increase, but until then clinical practice must be dictated by the current evidence available.

Prevention of remote organ injury in cardiopulmonary bypass: the impact of flow generation technique.

The purpose of this study was to investigate the effects of 3 different types of flow generation for cardiopulmonary bypass on gastrointestinal permeability and on neutrophil expression of CD11b, a surface marker of neutrophil activation. Fourteen patients undergoing elective coronary revascularization were selected randomly to receive 1 of the 3 flow generation techniques (roller, pulsatile, or centrifugal). Intestinal permeability was assessed by the fraction of an oral dose of 51chromium-ethylenediaminetetraacetate (51Cr-EDTA) recovered in the urine over 24 h. Neutrophil activation was determined by expression of CD11b markers at 6 time points. Overall, the 14 patients showed significant increases in intestinal permeability. It was not possible to demonstrate statistically significant differences among the flow generation groups; however, when compared to both roller pump groups, the centrifugal pump group showed a 3.2% reduction in intestinal permeability. There was no change in the expression of CD11b receptors throughout the time points, nor was there a relationship of CD11b markers to the flow generation technique.

Traumatic disruption of the thoracic aorta: a rational approach to imaging.

An imaging strategy is crucial in patients who have sustained a traumatic disruption of the thoracic aorta. Of those who reach hospital alive, 70-90 per cent will survive if diagnosed early and treated appropriately. The clinician has many imaging techniques to choose from, but they vary considerably in their degree of accuracy and performance time. Consequently their appropriateness is dependent on the type of injury suspected, the haemodynamic stability of the patient and the availability and experience of the radiologists. This article describes the types and presentation of traumatic thoracic aortic disruption so that the advantages and disadvantages of the various imaging modalities can be explained. It concludes by presenting an imaging strategy for use when this condition is suspected.

Management of acute dilatation of the oesophagus presenting as stridor.

Acute dilatation of the oesophagus causing stridor is rare. A case is presented and the literature is reviewed with emphasis on the management of this problem.