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One of the most commonly used tools by clinicians to identify cases of anxiety and depression in medically ill patients is the Hospital Anxiety and Depression Scale, or the HADS Filipino version. However, there were some "gray areas" with its use, particularly for those who are in the non-psychiatric setting. Some translated items may pertain to something else which could influence patients' responses. Furthermore, local studies showed differences in the conception, understanding, and expression of depression unique to Filipino culture and could be potentially missed during the assessment. This paper determined the validity and reliability of the Anxiety and Depression Symptom Assessment Guide or ADSA to a sample of 91 adult cardiac Filipino patients in the in-patient setting. In addition to the 29-item ADSA tool that was generated from HADS, the review of literature and other sources was also reviewed by experts from two rounds of Delphi Survey. It was written in a yes-or-no format and available in both English and Filipino versions. The tool was tested for internal consistency, intra-class and inter-item reliability. Another test used was criterion-based validity utilizing HADS to identify cases of anxiety and depression. The results showed that ADSA is highly reliable with Cronbach's alpha of 0.97, poor-to-moderate intra-class correlation (0.670 for anxiety, 0.440 for depression), and consistent/acceptable interitem correlation (0.528 for anxiety, 0.382). Both HADS and ADSA were positively correlated with correlation coefficients of 0.667 and 0.391 (p-value<0.5) for anxiety and depression respectively. Using a cut-off score of 5, ADSA has moderate sensitivity and specificity of 72.5% and 78.4% for anxiety, and 66.7% and 64.3% for depression. Further research is needed to strengthen ADSA's validity by increasing the sample size and the multi-center sites. [ABSTRACT FROM AUTHOR]

Background: The role of ACTA2 mutations in Familial Aortic Disease has been increasingly recognized. We describe a highly penetrant variant (R118Q) in a family with aortic disease. Case report: A patient presented to us for elective repair of an ascending aortic aneurysm with a family history of his mother expiring after aortic dissection. Genetic testing revealed he was a heterozygous carrier of the ACTA2 missense mutation R118Q. Subsequently, all living family members were tested for this variant and a full medical history was obtained to compile a family tree for the variant and penetrance of an aortic event (defined as lifetime occurrence of aortic surgery / dissection). In total 9 family members were identified and underwent genetic testing with 7/9 showing presence of the ACTA2 R118Q mutation or an aortic event. All patients over the age of 50 (n = 4) had an aortic event. Those events occurred at ages 54, 55, 60, and 62 (mean event at 57.8 ± 3.9 years). Three family members with the variant under the age of 40 have not had an aortic event and most are undergoing regular aortic surveillance via CT scan. Conclusions: Existing studies of known ACTA2 mutations describe a 76% aortic event rate by 85 years old. The R118Q missense mutation is a less common ACTA2 variant, estimated to be found in about 5% of patients with known mutations. Prior studies have predicted the R118Q mutation to have a slightly decreased risk of aortic events compared to other ACTA2 mutations. In this family, however, we demonstrate 100% penetrance of aortic disease above age 50. In today's era of excellent outcomes in elective aortic surgery, our team aggressively offers elective repair. We advocate for strict aortic surveillance for patients with this variant and would consider elective aortic replacement at 4.5 cm, or at an even smaller diameter in patients with a strong family history of dissection who are identified with this mutation. [ABSTRACT FROM AUTHOR]

Purpose: There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID‐19 pandemic. This study examined presentation patterns and outcomes of ATAAD in North America immediately before, and during, the COVID‐19 pandemic. Methods: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was queried to identify patients presenting with ATAAD in the 12 months pre‐pandemic (March 2019–February 2020), and during the early pandemic (March through June 2020). Demographics and operative characteristics were compared using χ² test and Wilcoxon Rank‐sum test. The median annual case volume designated low‐volume centers versus high‐volume centers (>10 cases per month). Step‐wise variable selection was used to create a risk set used for adjustment of all multivariable models. Results: There were 5480 patients identified: 4346 pre‐pandemic and 1134 during pandemic. There was significantly lower volume of median cases per month during the COVID‐19 pandemic period (286 interquartile range [IQR]: 256–306 vs. 372 IQR: 291–433,p =.0152). In historically low‐volume centers (<10 cases per year), there was no difference in volume between the two periods (142 IQR: 133–166 vs. 177 IQR: 139–209, p = NS). In high‐volume centers, there was a decline during the pandemic (140 IQR: 123–148 vs. 212 IQR: 148–224, p =.0052). There was no difference in overall hospital‐to‐hospital transfers during the two time periods (54% of cases pre‐pandemic, 55% during). Patient demographics, operative characteristics, malperfusion rates, and cardiac risk factors were similar between the two time periods. There was no difference in unadjusted operative mortality (19.01% pre‐pandemic vs. 18.83% during, p =.9) nor major morbidity (52.42% pre‐pandemic vs. 51.24% during, p =.5). Risk‐adjusted multivariable models showed no difference in either operative mortality nor major morbidity between time periods. Conclusions: For patients presenting to the hospital with ATAAD during the first surge of the pandemic, operative outcomes were similar to pre‐pandemic despite a 30% reduction in volume. Out‐of‐hospital mortality from ATAAD during the pandemic remains unknown. Further understanding these findings will inform management of ATAAD during future pandemics. [ABSTRACT FROM AUTHOR]

Background: With evolutions in technique, recent data encourage the use of cerebral perfusion during aortic arch repair. However, a randomized data have demonstrated higher rates of neurologic injury according to MRI lesions using antegrade cerebral perfusion during hemiarch reconstruction.Methods: This was a retrospective review of two institutional aortic center databases to identify adult patients who underwent aortic hemiarch reconstruction for elective aortic aneurysm or acute type A aortic dissection. Patients were stratified according to cerebral protection method: (1) deep hypothermic circulatory arrest (DHCA) group versus (2) DHCA/retrograde cerebral perfusion (RCP) group.Results: A total of 320 patients and 245 patients underwent hemiarch reconstruction for aortic aneurysm electively and aortic dissection, respectively. In aneurysmal pathology, the DHCA group included 133 patients and the DHCA/RCP group included 187 patients. Operative mortality was 0.8% in the DHCA group and 2.7% in the DHCA/RCP group (p = 0.41). Kaplan-Meier survival estimates revealed comparable 2-year survival (p = 0.14). In dissection, 43 patients and 202 patients were included in the DHCA group and the DHCA/RCP group, respectively. Operative mortality was equivalent between the two groups (11.6% in the DHCA group and 9.4% in the DHCA/RCP group, p = 0.58). Long-term survival was similar at 2 years between the groups (p = 0.06). Multivariable analysis showed cerebral perfusion strategy was not associated with the composite outcome of operative mortality and stroke.Conclusions: In treating both elective and acute ascending aortic pathologies with hemiarch reconstruction, both DHCA alone or in combination with RCP yield comparable results. [ABSTRACT FROM AUTHOR]

Background Complete embolization of a prosthetic heart valve is extremely rare and dangerous. This case reports a total embolization of a mechanical aortic valve and contributes to the literature regarding the diagnostic challenges related to infective endocarditis and follow-up after valvular surgery. Case summary A 28-year-old male 11.5 years status-post a mechanical aortic valve replacement presented with acute onset of chest pain and dyspnoea while jogging. The patient lost consciousness and went into cardiopulmonary arrest with acute pulmonary oedema and circulatory shock. An echocardiogram revealed an empty aortic annulus, and a chest radiograph showed an embolized valve in the aortic arch. The patient underwent emergent removal of the embolized valve and replacement with a new mechanical aortic valve. The patient survived with minimal sequelae. At a 3-month follow-up, he had resumed work, and the only sequelae were mild left ventricular dysfunction and minor vision loss. Although he experienced no warning signs or symptoms, the most likely aetiology for embolization of the valvular prosthesis was infective endocarditis, which was revealed by re-evaluation of an echocardiogram recorded 1 month before the presentation which demonstrated a subtle motion abnormality of the valve. Conclusions We present a case of a late complete embolization of a mechanical aortic valve most likely caused by asymptomatic infective endocarditis. The case illustrates the challenges in follow-up after valvular surgery and highlights the ultimate benefit of a well-functioning pre-hospital to hospital chain. [ABSTRACT FROM AUTHOR]

A low-cost technique of propagation study to determine the influence of leaf number and relationship among rooting trait and cutting size was carried out on cuttings from seedlings of Aquilaria cumingiana. The highest percentage of rooting was detected in cuttings with two leaves (83.62%) and lowest in cuttings with the greatest (3) number of leaves (50%). Comparison of the means revealed a significant increase in percent rooting, number of roots, and length of the longest root on cuttings with two leaves. Correlation analysis among root traits revealed significant (P < 0.0001) low to high positive relationships (r2 = 0.26-0.91). The strongest association was recorded between the average root length and the length of the longest root (r2 = 0.91, P < 0.0001). All relationships between the rooting trait and the cutting size displayed weak and non-significant (r2 = 0.04-0.17, P > 0.05) - suggesting that aside from amount, variation in distribution and transport of naturally occurring endogenous auxin might probably affect the rooting. This study generated an economical and practical protocol to vegetatively massproduce this premium species. Further studies are recommended, particularly with regards to auxin quantification to identify and quantify the specific naturally occurring endogenous auxin that is affecting the rooting of A. cumingiana. [ABSTRACT FROM AUTHOR]

Objective: Valve‐sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type‐A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002–2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow‐up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal‐perfusion or shock. The FS was combined with hemi‐arch replacement in 15 (62.5%) patients and a zone‐2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow‐up period was 46 months (range, 0.3–146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve‐sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type‐A aortic dissection with excellent early and long‐term results. [ABSTRACT FROM AUTHOR]

Shoots arising from the stump of a mature tree of Pterocarpus indicus Willd. were used to evaluate the within-tree variation in rooting induction. Collected rejuvenated stem cuttings were separated into three different positions (base, middle, and top) and treated with various indole butyric acid (IBA) concentrations (0, 500, and 1000 ppm). Cuttings were planted in an improvised rooting chamber for rooting induction. Results of the analysis of variance achieved non-significant effects (P > 0.05) due to IBA treatment in all rooting parameters evaluated after 33 d. In contrast, a highly significant increase in the number of roots (0.93, P = < 0.001) was detected in terms of cutting position, particularly at the middle part. Similarly, apart from callus formation (P > 0.05), significant increase in percent rooting (46.83%, P = 0.0012) and number of secondary roots (0.93, P = 0.0011) were obtained from the same position. Meanwhile, nonsignificant effects were also recorded in terms of IBA and cutting position interaction, except from callus formation (P = 0.036). Means separated by DMRT revealed that the interaction effect between middle position and IBA500 ppm (0.13) and those between top position and IBA1000 ppm (0.58) were significantly different. This study has proven the presence of withinstem variation; hence, rooting responses vary in cuttings collected from epicormic shoots arising from the stump of physiologically mature P. indicus. [ABSTRACT FROM AUTHOR]

Cor‐Knot fastener use in sternotomy‐based aortic arch procedures has not been reported. We present Cor‐Knot fastener use over a Hegar dilator in an anatomically challenging total aortic arch replacement with no short‐term and/or long‐term complications. [ABSTRACT FROM AUTHOR]

Background: Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae.Case Presentation: A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management-anti-impulse regimen, antiplatelet therapy, and close follow-up.Conclusions: Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary. [ABSTRACT FROM AUTHOR]

Rajah Sikatuna Protected Landscape (RSPL), considered the last frontier within the Central Visayas region, is an ideal location for flora and fauna research due to its rich biodiversity. This recent study was conducted to determine the plant species composition and diversity and to select priority areas for conservation to update management strategy. A field survey was carried out in fifteen (15) 20 m x 100 m nested plots established randomly in the forest over limestone of RSPL from July to October 2019. Three hundred and sixty eight (368) species of plants were identified up to species level. This represented 327 angiosperms, one gymnosperm and 40 pteridophytes. Common plant families with more than 10 representative species were Moraceae, Meliaceae, Lauraceae, Dipterocarpaceae, Rubiaceae, Myrtaceae, Phyllanthaceae, Annonaceae, Araceae and Lauraceae. There were 93 (28%) endemic and 46 (14%) threatened species (vulnerable to critically endangered) observed. The cluster analysis and species accumulation curve suggests that plant species are not homogeneously distributed which implies that different management and conservation strategies should be implemented across RSPL. These results not only indicate the importance of RSPL, but also highlights areas with higher diversity and concentration of threatened and endemic species as a special area of concern. Furthermore, areas with high biodiversity value were recommended for immediate protection, while areas with low biodiversity value were recommended for reforestation programmes using species with high importance value. [ABSTRACT FROM AUTHOR]

Objective: The index for mortality prediction after cardiac transplantation (IMPACT) risk score incorporates 12 preoperative recipient-specific variables, and has been validated as an accurate predictor of short- and long-term mortality after orthotopic heart transplantation (OHTx). We believe it can also be used to predict hospital costs, and we hypothesize that higher preoperative IMPACT risk scores are associated with increased hospital resource consumption.Methods: All OHTx patients ≥18 years of age at our institution were reviewed from 1 January 2000 to 31 December 2014. Total index hospitalization costs post-transplant were extracted and presented in 2014 consumer price index inflation-adjusted US dollars. Patients were stratified into quartiles (Q) according to IMPACT risk scores. Logarithmic transformation normalized cost data, and linear regression assessed for correlation. A comparison of cost between Q of IMPACT risk score was performed using rank-sum and Kruskal-Wallis tests. Survival was estimated using the Kaplan-Meier method.Results: Three hundred fifty-six (n = 356) OHTx were performed during the study period. The median IMPACT score for the cohort was five (interquartile range [IQR] 3-6). Eight (2.2%) patients died within 30-days and 1-year Kaplan-Meier survival was 88.3%. The median length of stay (LOS) was 16 (IQR 14-24) days. The median hospital cost for index admission was $222 200 (IQR:$169 200-$313 700). Median LOS was longer in Q4 vs Q1 (18 days vs 15 days, P = .01) and index hospital costs in Q4 were significantly higher compared to Q1 patients ($280 400 vs $205 000, P < .01). There was a significant positive correlation between IMPACT risk score and cost (regression coefficient .04, P < .01).Conclusion: This is the first study in adult cardiac transplantation to identify a positive correlation between hospital cost and recipient risk using the IMPACT risk score. Cost and resource consumption for the index admission after OHTx were significantly higher in the highest IMPACT risk Q compared with patients in the lowest Q. [ABSTRACT FROM AUTHOR]

The caves in the Philippines are habitats for bat species but are threatened by anthropogenic activities. This study assessed the vulnerability of cave bats in three KBAs (Key Biodiversity Areas) of Central Visayas: Mt. Bandilaan in Siquijor (13 caves), Mabinay, Negros Oriental (12 caves), and Rajah Sikatuna Protected Landscape in Bohol (31 caves). The study was conducted between February 14 to September 20, 2019. Field survey methods included mistnetting at the cave entrances and direct observations of roosting sites in each cave. Of the 56 caves surveyed, 36 caves were inhabited by bats. A total of 16 cave-dwelling bat species belonging to 7 families were recorded. Five species are Philippine endemics (Hipposideros obscurus, Hipposideros pygmaeus, Ptenochirus jagori, Rhinolophus inops, and R. rufus) and three Near-threatened species (H. lekaguli, M. schreibersii, and R. rufus). The Bat Cave Vulnerability Index (BCVI) was adopted to determine priority sites for conservation. Two cave sites (Canganhao in Siquijor and Mambajo in Mabinay), inhabited by relatively high bat populations, were determined high priority levels. We urge the concerned agencies to strengthen conservation measures in these caves. Prevailing threats included treasure hunting, bat hunting, guano extraction, land conversion, locals' illegal entry, graffiti, among others), and tourism activities. [ABSTRACT FROM AUTHOR]

Objective: Highlight our management of a Pasteurella Multiocida-infected descending thoracic aorta mycotic pseudoaneurysm.Methods: Report a case of a canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm.Results: We present a 61-year-old gentleman who was initially seen in an emergency department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks after discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete pseudoaneurysm resection and aortic replacement with a 24-mm Gelweave graft. Given purulence and gross infection, we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with 6-week intravenous course of antibiotics.Conclusions: The patient's clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms. [ABSTRACT FROM AUTHOR]

Objective: This study highlights the management strategy in simultaneous bicuspid aortic valve infective endocarditis and mycotic pseudoaneurysm of an aortic coarctation.Methods: A staged repair of mycotic pseudoaneurysm of aortic coarctation and infective bicuspid aortic valve endocarditis.Results: We present a 19-year old gentleman who was admitted with aching pain in his bilateral lower extremities with associated purpuric rash and fevers. Work-up was significant for severe aortic valve regurgitation and a pseudoaneurysm in the distal aortic arch. He underwent operative repair through a left posterior-lateral thoracotomy with femoral-femoral partial cardiopulmonary bypass. Intraoperative findings were significant for a juxta-ductal coarctation and pseudoaneurysm. The mycotic pseudoaneurysm and remnant ligamentum arteriosum were completely resected and were replaced with a 18 mm Gelweave graft (Terumo Cardiovascular Group, Ann Arbor, MI) from the distal arch to the descending thoracic aorta. The patient underwent a planned secondary washout and omental flap for biologic coverage of the graft. Subsequently, a staged aortic valve replacement was completed 1 week later. The patient's postoperative course was uncomplicated, and he was discharged with intact motor and sensory function.Conclusions: A staged approach is a prudent strategy to manage a patient with simultaneous endocarditis and aortic mycotic pseudoaneurysm, with precedence toward the most critical lesion. [ABSTRACT FROM AUTHOR]

Acute DeBakey I or II aortic dissection (AD) is a surgical emergency with significant mortality if not repaired immediately. We present the case of a 49-year-old man with acute type I AD, who initially underwent zone 2 arch replacement for a primary arch tear. A calcified ductus arteriosus was noted during arch reconstruction. He exhibited exsanguinating hemorrhage from the proximal descending thoracic aorta upon an initial attempt to wean off cardiopulmonary bypass. Hemostasis was achieved with retrograde transfemoral thoracic endovascular aortic repair and transmediastinal external cinch around the descending aorta to obliterate false lumen flow. [ABSTRACT FROM AUTHOR]

Introduction There is an absence of widely accepted guidelines for the management of infectious intracranial aneurysms (IIAs) owing to a dearth of high-quality evidence in the literature. Objective To better define the incidence of IIAs, treatment practices, and patient outcomes by performing a Nationwide Inpatient Sample (NIS) database query. Methods We queried the NIS database from 2002 to 2011 for all patients with the primary diagnosis of infectious endocarditis (IE), subarachnoid hemorrhage (SAH), or unruptured cerebral aneurysm by ICD-9-CM codes. ICD-9 procedure codes were used to identify patients undergoing neurosurgical or cardiothoracic procedures. Results The query identified 393 patients with primary diagnosis of IE, SAH or unruptured cerebral aneurysm treated during 2002-2011. The mean age of the patients was 53.5 years; 244 (62%) were male. The majority of patients presented with SAH (361; 91.9%). Only 73 (18.6%) patients underwent neurosurgical coiling or clipping for IIA. Of patients undergoing a neurosurgical procedure, 65 had SAH (constituting only 18% of patients with SAH) and 8 had unruptured aneurysms (constituting only 25% patients with unruptured aneurysms). Cardiac procedures were performed in only 72/393 patients (18.3%) patients. Only 67 (18.6%) of the patients with SAH and 5 (15.6%) with unruptured aneurysms underwent a cardiac corrective surgical procedure. Mortality was significantly higher in those patients managed conservatively (26.7%) than in those who underwent clipping or embolization (15.1%; p<0.001). Conclusions In this NIS database study, the majority of patients with IIAs were managed non-operatively, regardless of rupture status. Further investigation is warranted to standardize the management of these lesions. [ABSTRACT FROM AUTHOR]

Objectives: To study the short and mid-term outcomes of thoracic aortic operations in patients ≥80 years old. Methods: This is a retrospective chart review of patients ≥80 years old who underwent thoracic aortic operation in our institution between 2006 and 2013. Results: Ninety-eight patients were studied. Fifty-four patients underwent open repair; 41 underwent endovascular repair; and three underwent hybrid repair with aortic arch debranching and subsequent endovascular stent graft. Hospital mortality rate among the entire cohort was 11/98 (11%): 7/54 (13%) for open repair; 2/41 (5%) for endovascular repair; and 2/3 (66%) for hybrid repair. Major adverse events occurred in 23/98 (23%) in the entire cohort: 15/54 (28%) in open repair; 5/41 (12%) in endovascular repair; and 3/3 (100%) in hybrid repair. Mean follow-up was 31 ± 28 months (median 26 months). Two- and five-year survival rates were 57%, and 34% for the open approach and 71%, and 43% for the endovascular approach respectively. Conclusions: Both open and endovascular thoracic aortic repairs can be performed with favorable mortality and perioperative morbidity in appropriately selected octogenarian patients. doi: 10.1111/jocs.12722 (J Card Surg 2016;31:334-340). [ABSTRACT FROM AUTHOR]

The dyskinesia of Parkinson's Disease is most likely due to excess levels of dopamine in the striatum. The mechanism may be due to aberrant synthesis but also, a deficiency or absence of the Dopamine Transporter. In this study we have examined the proposition that reinstating Dopamine Transporter expression in the striatum would reduce dyskinesia. We transplanted c17.2 cells that stably expressed the Dopamine Transporter into dyskinetic rats. There was a reduction in dyskinesia in rats that received grafts expressing the Dopamine Transporter. Strategies designed to increase Dopamine Transporter in the striatum may be useful in treating the dyskinesia associated with human Parkinson's Disease. [ABSTRACT FROM AUTHOR]

We present an endovascular technique to repair an ascending aortic pseudoaneurysm in a patient with multiple previous sternotomies using access via the right common carotid artery. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the effect caffeine ingestion had on maximal voluntary contraction strength in upper and lower body muscle groups. Researchers evaluated 16 resistance trained men who received either caffeine or a placebo. They found that a moderate dose of caffeine improved maximal voluntary contraction strength in the men regardless of the location of muscle groups.

We retrospectively report the first use of intrathecal morphine prior to incision in two male patients undergoing a complex aortic reconstruction, who required complete circulatory arrest under deep hypothermia for intraoperative and postoperative pain control. We administered intrathecal morphine to two male patients undergoing circulatory arrest and deep hypothermia. Patients were fully heparinized prior to cardiopulmonary bypass. Deep hypothermic circulatory arrest was performed by cooling the patients to 18°C. Following the surgery, the neurologic status was monitored. The management of postoperative pain is a quality standard in health care. During the first 24 hours after surgery, we observed excellent analgesia without the associated side effects, thus, reducing the time required for pain control by the nursing staff. A successful analgetic strategy not only enhances the patient satisfaction, but may improve the postoperative outcome. However, complications, such as increased risk of epidural hematoma formation, are of special concern in cardiac surgery. [ABSTRACT FROM AUTHOR]

Background Galectin-3, one of the β-galactoside-binding lectins, has been suggested as a marker of disease progression in melanoma patients because of its overexpression observed in recent studies. However, prognostic value of galectin-3 in primary cutaneous melanoma (PCM) has not been clearly defined. Objectives The aim of the study was to analyse whether the intensity of galectin-3 expression can predict survival in patients with PMC. Methods Galectin-3 expression was evaluated using immunohistochemistry in 104 PCM samples, including 71 (68.2%) superficial spreading (SSM) and 33 (31.8%) nodular melanomas (NM). Results Significant difference of galectin-3 expression between SSM and NM was determined ( P < 0.001). Increased galectin-3 expression was positively correlated with tumour thickness ( P < 0.001), Clark ( P < 0.001) and Breslow ( P < 0.001) stage, mitotic rate ( P < 0.001), presence of tumour ulceration ( P < 0.001), lymphatic invasion ( P = 0.018), positive sentinel lymph node ( P < 0.022) and distant metastases ( P < 0.001). Kaplan-Meier analysis showed an association between increased galectin-3 expression and reduced recurrence-free survival (RFS) ( P = 0.001) and reduced disease-specific survival (DSS) ( P = 0.015). In Cox proportional hazards regression analysis, significant predictors of reduced RFS were positive sentinel lymph node ( P = 0.025) and lymphovascular invasion ( P = 0.021), whereas predictors of DSS were tumour thickness ( P = 0.012), lymphovascular invasion ( P = 0.047), Clark stage ( P = 0.029) and location of tumour on upper extremities ( P = 0.024). Conclusions Our results support the potential role of galectin-3 in PCM development, progression and metastasis. Moreover, galectin-3 could serve as an additional prognostic marker that might help in further stratifying the risk of disease progression and metastasis in patients with PMC. [ABSTRACT FROM AUTHOR]

Connexins (Cxs) are a family of transmembrane proteins that build cell-to-cell channels in gap junctions. Gap junctions composed of Cxs have an essential role in intercellular communication, adhesion and cell differentiation. Several studies investigated the role of connexin43 (Cx43) in different carcinomas; however, none investigated its prognostic role in prostate cancer. Cx43 expression and relationship with established prognostic features were assessed in a cohort of 102 patients treated with radical prostatectomy for clinically localized prostate adenocarcinoma. Cx43 expression in prostate cancer was significantly associated with established features indicative of worse prognosis, such as follow-up time (P<0.001) and preoperative PSA (P<0.007). Patients with lower Cx43 expressions in tumours have shorter follow-up time, which indicated shorter disease-free survival and higher preoperative PSA values. Furthermore, tumours with positive surgical margins (P<0.001) showed significantly lower Cx43 expression compared with tumours without this feature. In univariate (P<0.001) and multivariate (P=0.014) analyses, decreased Cx43 expression was found to be a significant predictor of biochemical recurrence free-survival. Study results show the association of decreased Cx43 expression with prostate cancer progression. Moreover, Cx43 could serve as an additional prognostic marker and used together with traditional prognostic markers might help in further stratifying the risk of disease progression in patients with prostate cancer. [ABSTRACT FROM AUTHOR]