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There is limited literature exploring how nonmedical factors such as social determinants of health (SDOHs) are associated with postoperative outcomes following shoulder arthroplasty. A retrospective cohort review of the Pearl Diver Database was used to capture patients undergoing either primary anatomic total or reverse shoulder arthroplasty from the fourth quarter of 2015 to the third quarter of 2019 with at least 1 year of active longitudinal follow-up. Patients with proximal humeral fractures, stress fractures, or septic arthritis were excluded. The included patients were then divided into 2 cohorts based on the presence of current SDOHs or a history of SDOHs. The SDOH cohort comprised 4 non–mutually exclusive categories: economic, educational, social, and environmental disparities. Subsequently, a control cohort was matched at a 1:1 ratio to the SDOH cohort. Primary outcome measures were assessed using a logistic regression and consisted of the following 90-day postoperative complications: minor and major medical complications and infection. Emergency department (ED) visits and readmissions for any cause were also assessed. Additionally, the following 1-year outcomes were assessed: aseptic loosening, instability, and revision arthroplasty. Surgical costs and 90-day postoperative costs were collected using averaged insurance reimbursements for both the control and SDOH cohorts. There were 5190 patients in each cohort. Economic disparities made up the largest portion of the SDOH cohort (n = 4631, 89.2%), followed by social (n = 741, 14.3%), environmental (n = 417, 8.0%), and educational (n = 99, 1.9%) disparities. Compared with the control cohort, SDOHs were associated with an increased risk of major complications (2.3% vs. 1.4%; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.29-1.87; P <.001), minor complications (5.7% vs. 3.8%; OR, 1.62; 95% CI, 1.21-1.95; P =.001), readmissions (4.3% vs. 2.8%; OR, 1.56; 95% CI, 1.26-1.84; P <.001), and ED visits (15.2% vs. 11.0%; OR, 1.45; 95% CI, 1.29-1.63; P <.001) within 90 days following surgery. Additionally, SDOHs were associated with an increased risk of aseptic loosening (1.1% vs. 0.6%; OR, 1.85; 95% CI, 1.20-2.65; P =.006), instability (4.0% vs. 2.2%; OR, 1.80; 95% CI, 1.43-2.28; P <.001), and ipsilateral revision (9.2% vs. 7.6%; OR, 1.24; 95% CI, 1.08-1.43; P <.001) at 1 year postoperatively compared with the control cohort. SDOHs are associated with increased rates of adverse outcomes following shoulder arthroplasty including revision surgery, ED visits, length of stay, and overall cost compared with matched controls without SDOHs. Specifically, economic and educational disparities are associated with increased rates of adverse outcomes following surgery including revision surgery, ED visits, length of stay, and overall cost. [ABSTRACT FROM AUTHOR]

Background Context: Spinal epidural abscess is a rare but severe condition with high rates of postoperative adverse events.Purpose: The objective of the study was to identify independent prognostic factors for reoperation using two datasets: an institutional and national database.Study Design/setting: Retrospective Review.Patient Sample: Database 1: Review of five medical centers from 1993 to 2016. Database 2: The National Surgical Quality Improvement Program (NSQIP) was queried between 2012 and 2016.Outcome Measures: Thirty-day and ninety-day reoperation rate.Methods: Two independent datasets were reviewed to identify patients with spinal epidural abscesses undergoing spinal surgery. Multivariate analyses were used to determine independent prognostic factors for reoperation while including factors identified in bivariate analyses.Results: Overall, 642 patients underwent surgery for a spinal epidural abscess in the institutional cohort, with a 90-day unplanned reoperation rate of 19.9%. In the NSQIP database, 951 patients were identified with a 30-day unplanned reoperation rate of 12.3%. On multivariate analysis in the NSQIP database, cervical spine abscess was the only factor that reached significance for 30-day reoperation (OR=1.71, 95% CI=1.11-2.63, p=.02, Area under the curve (AUC)=0.61). On multivariate analysis in the institutional cohort, independent prognostic factors for 30-day reoperation were: preoperative urinary incontinence, ventral location of abscess relative to thecal sac, cervical abscess, preoperative wound infection, and leukocytosis (AUC=0.65). Ninety-day reoperation rate also found hypoalbuminemia as a significant predictor (AUC=0.66).Conclusion: Six novel independent prognostic factors were identified for 90-day reoperation after surgery for a spinal epidural abscess. The multivariable analysis fairly predicts reoperation, indicating that there may be additional factors that need to be uncovered in future studies. The risk factors delineated in this study through the use of two large cohorts of spinal epidural abscess patients can be used to improve preoperative risk stratification and patient management. [ABSTRACT FROM AUTHOR]

Background: Surgeons are increasingly performing total hip arthroplasty (THA) in the outpatient setting. Lower lengths of stay (LOS) could result in fewer lower extremity ultrasounds for deep vein thromboses (DVT). The objective of this study was to evaluate the incidence of lower extremity ultrasounds ordered and positive DVT results in the immediate postoperative period.Methods: All patients undergoing elective primary THA at an academic tertiary care center from January 2010 to February 2020 were included. Primary outcome of interest was incidence of postoperative DVT ultrasounds while inpatient and within 2 weeks following THA. Statistical analysis, including descriptive statistics and significance testing, was performed.Results: A total of 3,665 patients were included, of which, 2.0% (N = 72) of patients received a lower extremity ultrasound while inpatient, with only 2 being positive (2.8%), for an overall positivity rate of 0.05% of the entire cohort. The incidence of postoperative inpatient ultrasounds decreased from 7.0% in 2010 to 0.3% in 2020 (P < .001) whereas, the incidence of ultrasounds at 2 weeks and 2-week positivity rate remained stable. LOS was identified as a risk factor for postoperative inpatient ultrasound (P < .001).Conclusions: Postoperative ultrasounds to evaluate for DVT are associated with a low yield and appear to be a consequence of reduced LOS in the hospital. Given the stable diagnosis rate of DVT at 2 weeks, our data suggests that the increasing trend toward outpatient arthroplasty will not result in missed opportunities to diagnose postoperative DVTs or lead to adverse outcomes and may provide benefit to patients by eliminating unnecessary testing.Level Iii Evidence: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

To determine if a penicillin allergy is an independent risk factor for poor outcomes after anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF). A retrospective database review was performed using the PearlDiver data set. The study population included all patients younger than 85 years who underwent elective PLF or ACDF with diagnosis of penicillin allergy using International Classification of Diseases codes. Study patients were compared with controls for 90-day complications and 1-year reoperation rates. A multivariate logistic regression was used to determine the independent effect of penicillin allergy on the postoperative outcomes. PLF cohort multivariate analysis showed that patients with a penicillin allergy had a significantly increased risk of sepsis (2.6% vs. 2.0%; P = 0.020), urinary tract infection (10.8% vs. 8.4%; P < 0.001), emergency room visits (27.3% vs. 20.2%; P < 0.001), and readmissions (9.6% vs. 6.4%; P < 0.001) within 90 days index of surgery. Similarly, the ACDF cohort multivariate analysis showed that a penicillin allergy was associated with an increased risk of sepsis (1.8% vs. 1.1%; P < 0.001), emergency room visits (27.2% vs. 20.7%; P < 0.001), and readmissions (6.8% vs. 5.6%; P = 0.003) within 90 days index of surgery. The present study found that a reported penicillin allergy is associated with an increase in sepsis, urinary tract infection, emergency room visit, and readmission postoperatively within 90 days after PLF and ACDF. The findings can help physicians provide patients with more comprehensive preoperative counseling in the setting of patient-reported penicillin allergy. [ABSTRACT FROM AUTHOR]

Obese patients undergoing orthopedic procedure have been reported to have higher rates of postoperative complications, but the published associations have numerous confounders. This study aims to evaluate the independent effect of obesity on postoperative complications and hospital utilization following ankle arthrodesis. A database review of a Medicare database was performed on patients less than 85 years old who underwent ankle arthrodesis between 2005 and 2014. Patient cohorts were defined using International Classification of Diseases-9 coding for body mass index (BMI)—obese (30-40 kg/m2), and morbidly obese (>40 kg/m2). Normal BMI patients were defined as those without the respect codes for obesity (30-40 kg/m2), morbidly obese (>40 kg/m2), or underweight (<19 kg/m2). All groups were propensity score matched by demographics and comorbidities. Outcomes of interest included 90-day major and minor medical complications, and hospital burden. Morbid obesity was associated with an increased risk of acute kidney injury (4.4% vs 2.4%, OR 1.94, 95% CI 1.37-2.74, p <.001), urinary tract infection (5.2% vs 3.2%, OR 1.66, 95% CI 1.21-2.25, p =.001), readmission (13.6% vs 10.8%, OR 1.33, 95% CI 1.10-1.61, p =.003), and overall minor complications (16.0% vs 11.8%, OR 1.44, 95% CI 1.19-1.74, p <.001) compared to normal BMI patients, and an increased risk for acute kidney injury (4.4% vs 1.9%, OR 2.25, 95% CI 1.32-3.97, p =.003) compared to obese patients. Obesity was not associated with increased medical complications (p >.05). While morbid obesity was associated with an increase in the postoperative complications, obesity was not associated with any increase in postoperative complications following ankle arthrodesis. [ABSTRACT FROM AUTHOR]

Aging athletes face unique, increased adversities related to increased mobility and age-related spine issues, such as spinal stenosis, osteoporosis complicated by fragility fractures, and degenerative disk disease. This article covers various spine pathologies that aging athletes experience and ideal treatment of this population to allow safe return to activity. [ABSTRACT FROM AUTHOR]

Mathematical modeling tries to simplify understanding and proposes a fundamental mechanism that governs the motion and function of a complex biological system such as a mitral valve (MV) motion which represents a dynamic interplay between papillary muscle (PM) position in the context of left ventricular (LV) shape dynamics. Current therapeutic strategies to intervene on the MV may not have exploited these relationships due to lack of understanding of the interactions. We present a MV 3D mathematical model characterized by LV shape dynamics to understand fundamental working principles of ventriculo-papillary-mitral complex. A complex 3D functional unit of MV apparatus was mathematically modeled based on a principle of dynamics. The model comprises of primary components including the annulus, anterior leaflet, posterior leaflet, chordae tendineae, anterior and posterior PM, and LV wall based on normal anatomical reference values from published series. Simulations based on Carpentier's classification of MV disease were created as well as based on LV shape dynamics and presented graphically. Autodesk Inventor (Autodesk Inc., San Rafael, CA) and Matlab (Mathworks, Natick, MA) were used for modeling and analysis. A stepwise analysis and mathematical models of the annulus, leaflets, chords, PMs, and LV were obtained by combining finite element analysis and computerized model creations. The model was then applied to Carpentier's functional classification. PM positions extrapolated based on different LV deformation in normal and mitral regurgitation (MR) model resulted in a different degree of MV leaflet coaptation with regurgitation (presented numerically and graphically). Abnormal MV coaptation was amended by manipulating PM positions independent with LV size or shape deformation, demonstrating that PM positioning maneuver may improve leaflet coaptation. LV dilation combined with increased interpapillary muscle distance turned out to intensify the level of leaflet prolapse, creating even greater regurgitation volume. Our mathematical model may provide a clue to complex interactions in play within a mitral, papillary, and LV complex. The model offers a possibility of manipulating various variables to obtain the desired outcome. [ABSTRACT FROM AUTHOR]

As the global population and economy grow, so does the energy demand. Over-reliance on non-renewable resources leads to depletion and price spikes, making renewable alternatives necessary. Biodiesel is an eco-friendly and non-toxic fuel that closely resembles traditional fossil fuels. It is produced from various sources, including animal fat, palm oil, and non-edible plant oil. Biodiesel releases fewer harmful air pollutants and greenhouse gases than fossil fuels and is simpler to manage. Despite these advantages, it cannot replace traditional diesel fuel on a large scale. This overview summarizes biodiesel production, explaining the different types of feedstock utilized and their benefits and drawbacks. Various biodiesel production methodologies are discussed. The primary objective of this article is to inform engineers, industrialists, and researchers involved in waste biodiesel, as well as to highlight waste biodiesel as a potential substitute for fossil fuels. This review article discusses the nano - additives in biodiesel and applications of internet of things, artificial intelligence, and machine learning in biofuel. This review shows that nano-additives can potentially improve biodiesel fuel properties, favorable economic and policy environments promoting biodiesel production, and internet of things, artificial intelligence, and machine learning technologies optimize the biodiesel production processes. These advances can help promote biodiesel as a cleaner, renewable energy source, lowering the consumption of fossil fuels. It also suggests further biofuel development by improving efficiency, expanding feedstock options, creating policy support, developing infrastructure, and increasing public awareness. • Biofuel methods, economic effects and sustainability with nano-additives discussed • Nano-additives transformed biodiesel with efficiency breakthroughs • Economic strategies and policy regulations driven sustainable biofuel transition • IoT, AI, and ML revolutionized biodiesel production and monitoring • Advancements in nano-additives and AI/ML technologies for biofuel sustainability [ABSTRACT FROM AUTHOR]

While stiffness of the lumbosacral spine is a known predictor of instability following total hip arthroplasty (THA), little is known about the medical- and surgical-related outcomes following THA in patients who have prior isolated sacroiliac (SI) joint arthrodesis. 197 patients who had a history of isolated SI joint arthrodesis who subsequently underwent elective primary THA for a diagnosis of osteoarthritis (THA-SI) from 2015 to 2021 were identified in a national administrative database. Using propensity score matching and logistic regression analyses, this cohort was compared to two groups of patients: patients who did not have any history of lumbar or SI arthrodesis and patients undergoing primary THA who had a history of lumbar arthrodesis without extension into the SI joint (THA-LF). The THA-SI group had a significantly higher incidence of dislocation (odds ratio 2.06, 95% confidence interval 1.04-4.04, P =.037) with no increased incidence of medical complications or other surgical complications when compared to patients without a history of SI or lumbar arthrodesis. There were no significant differences in any complications in THA-SI patients when compared to THA-LF patients. Patients who had prior isolated SI joint arthrodesis undergoing primary THA demonstrated a two-fold increased incidence of dislocation when compared to those who did not have prior SI arthrodesis, although the risk of complications in this population was similar to that observed in patients who had prior isolated lumbar spine arthrodesis. [ABSTRACT FROM AUTHOR]

A 65-year-old man presented with an infected perivisceral aortic aneurysm after previous treatment of an abdominal aortic aneurysm with an endograft. On presentation, he was septic and had occlusion of the celiac, superior mesenteric, inferior mesenteric, and bilateral renal arteries. He underwent a three-stage procedure: first, axillobifemoral bypass; then resection of the thoracoabdominal aorta; and finally bypass from the ascending aorta to the celiac and superior mesenteric arteries with a rifampin-soaked Gelsoft graft (Vascutek, Renfrewshire, Scotland). The abdominal pain resolved, and the patient remains symptom free 10 months postoperatively. This rare surgical revascularization technique offered a nontraditional solution to a difficult surgical issue. [ABSTRACT FROM AUTHOR]

The extent and type of nutrient limitation will affect soil microorganism activity and may change the balance between organism groups, like fungi and bacteria. Limiting nutrients have traditionally been measured as increased respiration after adding nutrients, but this will not differentiate between fungal or bacterial responses. We compared respiration, bacterial and fungal growth after alleviating limitation in soils originally being C-limited, but experimentally altered to N-limitation. Three soils of similar pH and organic matter but with different N availability were used. We amended the soils with C-rich substrates, starch (40 mg g −1 ) and straw (80 mg g −1 ), followed by a 4 weeks incubation at 22 °C to induce N-limitation. Starch amendment resulted in increased respiration and bacterial growth, while straw amendment increased all three variables (respiration, bacterial and fungal growth), with only minor differences between soils. Alleviating C- and N-limitation was then tested in a short-term assay after adding C (glucose) and NH 4 NO 3 in a full factorial design. In non-amended, C-limited soils, adding C resulted in increased respiration and especially bacterial growth, while fungal growth only increased in the High N soil. Straw amendment resulted in N-limitation, since adding N increased respiration and especially fungal growth. N-limitation for bacterial growth was evident in all starch amended soils, with similar effects for respiration, although adding C also increased respiration. Fungal growth was not affected by C- or N-additions in starch-amended soils. Thus, which microbial group that responded to alleviating N-limitation depended on the C-source in the soil. Furthermore, we found no indication of growth and respiration reacting differently to alleviating N-limitation indicating altered C-use efficiency. [ABSTRACT FROM AUTHOR]

pH, salinity and nutrient conditions are major determinants of microbial biomass, activity and community composition; all being hypothesized to favour bacterial over fungal activity. Soils from Pravaranagar (India), having high nutrient content and high pH (pH w 7.4–8.8), with sometimes increased salinity, were thus expected to have high bacterial/fungal ratios. Twelve soils were characterized for microbial growth, biomass, community structure and nutrient limitation. The phospholipid fatty acid (PLFA) pattern was typical for high pH soils, with relative high amounts of several unsaturated PLFAs, like 18:ω7, and relatively low in e.g. cy19:0. The adaptation to high pH was also seen in the bacterial community tolerance to pH, with optimum pH for growth around pH 7.5. The high pH had resulted in soils with high bacterial but low fungal growth. However, adding substrate conducive for fungal growth, like straw, could induce fungal growth. Some soils had high electric conductivity, indicating salinization. The bacterial community had developed increased tolerance to NaCl in these soils. These soils also differed in the PLFA pattern, suggesting that saline soils had more fungal biomass. In all soils bacterial growth was limited by lack of carbon, but secondary limitation due to nitrogen was also found, while phosphorus addition did not affect growth. The high nutrient condition was evident in more than 5-fold increases in bacterial growth in some soils when adding only C. We could thus show that in these soils, high pH, salinity and nutrient conditions all had affected soil microbial activity and community structure. Although the high pH favoured bacteria, this was, however, not found for high salinity soils. [ABSTRACT FROM AUTHOR]

Application of C-rich plant residues can change the soil system from C-limitation for microbial growth to limitation by other nutrients. However, the initial nutrient status of the soil may interact with the added amount of residues in determining limitation. We studied this interactive effect in soils from the Harvard Forest LTER, where annual addition of N since 1988 has resulted in soils with different N-status: No N (Unfertilized), 50 (Low N) and 150 (High N) kg N ha−1. We hypothesized that adding C-rich substrate would change the soil from being C- to being N-limited for bacterial growth and that the extent of N-limitation would be higher with increasing substrate additions, while becoming less evident in soil with increasing N-status. We compared the effect of adding two C-rich substrates, starch (0, 10, 20, 40 mg g−1 soil) and straw (0, 20, 40, 80 mg g−1), incubating the soils for up to 3 and 4 weeks for starch and straw, respectively. Nutrient limitations were studied by measuring bacterial growth 3 days after adding C as glucose and N as NH4NO3 in a full factorial design. Initially bacterial growth in all soils was C-limited. As hypothesized, adding C-rich substrates removed the C-limitation, with lower amounts of starch and straw needed in the unfertilized and Low N soils than in the High N soil. Combinations of different N-status of the soil and amendment levels of starch and straw could be found, where bacterial growth appeared close to co-limited both by available C and N. However, at even higher amendment levels, presumable resulting in N-limitation, bacterial growth still responded less by adding N then C-limited soils by adding C. Thus, in a C-limited soil there appeared to be N available immediate for growth, while in an N-limited soil, easily available C was not immediately available. [ABSTRACT FROM AUTHOR]

Abstract: Increasing nitrogen (N) deposition due to anthropogenic activities has become a significant global change threat to N-poor terrestrial ecosystems. We compared bacterial growth and nutrients limiting bacterial growth in one of the longest running experiments on increasing N-deposition to a temperate forest, the Chronic Nitrogen Amendment Study at Harvard Forest, USA. Soil samples were collected in fall 2009 from the organic and mineral horizons of plots treated annually since 1988 with 0 (unfertilized), 50 (low N) or 150 (high N) kg N ha−1 as NH4NO3. In the organic horizon, bacterial growth (leucine incorporation) decreased by 5 times in the high N plots compared to the unfertilized treatment, while no decrease was observed in the mineral horizon. Bacterial growth in all soils was primarily limited by lack of carbon (C), although adding only C (as glucose) resulted in only a minor increase in bacterial growth in the unfertilized soil compared to adding C in combination with N. The bacterial growth induced by adding only C increased with higher level of N fertilization, up to 7–8 times the level without any C addition in the high N treatment, suggesting increased availability of N for the bacteria with increasing N addition. [Copyright &y& Elsevier]

Background: The decision to proceed with total joint arthroplasty (TJA) can be complex and requires an assessment of potential risks of surgery. Patients who experience the potentially devastating complication of periprosthetic joint infection (PJI) may have a poor outcome and wish they had never elected to have surgery. No study has examined decision regret related to the choice to pursue TJA in patients who develop PJI.Methods: All patients who were treated for PJI with a two-stage revision at a tertiary academic medical center between 2010 and 2020 were surveyed. Ninety-six patients agreed to answer 12 questions concerning their understanding of their preoperative risk of infection and their level of regret with the decision to pursue index TJA. Patient regret was calculated using the Decision Regret Scale.Results: Seventy-two percent of patients reported that their joint replacement and concomitant infection had a severe ongoing impact on their quality of life, although only 28% of respondents regretted their choice to undergo index TJA, and 65% would undergo TJA again. A higher Musculoskeletal Infection Society outcome stage (typically due to failed treatment) and lower understanding of joint infection were associated with a higher level of regret on the Decision Regret Scale (P < .001).Conclusion: Self-reported decisional regret was present in only 1 in 4 patients who underwent arthroplasty despite experiencing a devastating complication, and almost two-thirds of patients with PJI reported they would undergo primary TJA again. Patients who were more informed about infection before TJA experienced less regret when they subsequently developed PJI.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Abstract: Mucosal delivery of vaccines against sexually transmitted pathogens is important to elicit strong immune responses at biologically relevant sites. However, inclusion of appropriate adjuvants is essential to overcome the inherent mucosal tolerance. We present evidence in support of the effectiveness of co-administering alpha-galactosylceramide (α-GalCer) as an adjuvant with a CTL-inducing HIV envelope peptide, via either oral or intranasal route, to prime antigen-specific immune responses in multiple systemic and mucosal compartments. Contrary to the known potential of repeated parenteral dosing with α-GalCer to induce NKT cell anergy that could compromise adoptive immunity development, we have observed that two and three doses delivered by the intranasal or oral route were more efficient in priming broader antigen-specific immune responses. These results demonstrate the effectiveness of α-GalCer as adjuvant for repeated intranasal or oral administration of vaccines for protection against mucosally transmitted pathogens. [Copyright &y& Elsevier]

Abstract: Targeted delivery of vaccine candidates to the gastrointestinal (GI) tract holds potential for mucosal immunization, particularly against mucosal pathogens like the human immunodeficiency virus (HIV). Among the different strategies for achieving targeted release in the GI tract, namely the small intestine, pH sensitive enteric coating polymers have been shown to protect solid oral dosage forms from the harsh digestive environment of the stomach and dissolve relatively rapidly in the small intestine by taking advantage of the luminal pH gradient. We developed an enteric polymethacrylate formulation for coating hydroxy-propyl-methyl-cellulose (HPMC) capsules containing lyophilized Adenoviral type 5 (Ad5) vectors expressing HIV-1 gag and a string of six highly-conserved HIV-1 envelope peptides representing broadly cross-reactive CD4+ and CD8+ T cell epitopes. Oral immunization of rhesus macaques with these capsules primed antigen-specific mucosal and systemic immune responses and subsequent intranasal delivery of the envelope peptide cocktail using a mutant cholera toxin adjuvant boosted cellular immune responses including, antigen-specific intracellular IFN-γ-producing CD4+ and CD8+ effector memory T cells in the intestine. These results suggest that the combination of oral adenoviral vector priming followed by intranasal protein/peptide boosting may be an effective mucosal HIV vaccination strategy for targeting viral antigens to the GI tract and priming systemic and mucosal immunity. [Copyright &y& Elsevier]

Background: Infectious complications of median sternotomy carry significant morbidity and mortality. However, the outcomes of noninfectious sternal dehiscence have not been addressed. We have identified the preoperative characteristics, postoperative complications, and long-term functional outcomes of patients after reoperation for noninfectious sternal dehiscence and compared these patients with a control group to determine risk factors for dehiscence. Methods: Retrospective review of the cardiac surgery database identified 48 patients with noninfectious sternal dehiscence in a group of 12,380 median sternotomies between 1994 and 2004. The review included diagnosis, demographics, concomitant medical conditions, and surgical outcomes. Functional outcomes were assessed using the Short Form-12 questionnaire. One hundred fifty-six median sternotomy patients served as controls. Follow-up was 97.9% (47 of 48 patients) complete, for a total of 150.1 patient-years. Results: Mean age of patients at reoperation was 58.8 ± 12.8 years, with a male to female ratio of 45:3. Multivariate analysis determined that New York Heart Association class IV, obesity, and chronic obstructive pulmonary disease were preoperative risk factors for sternal dehiscence. The incidence of sternal dehiscence was 0.39% at a mean interval between initial operation and reoperation of 5.4 months. At a mean interval of 3.9 months, 14.6% (7 of 48) of patients required additional sternal procedures. Infectious complications after reoperation occurred in 12.5% (6 of 48). Functional outcomes demonstrated that 72.2% (26 of 36) had no or mild limitation of physical activities, with 90.5% (38 of 42) reporting no or mild sternal pain at follow-up. Conclusions: Although patients undergoing surgical correction of noninfectious sternal dehiscence fare better than those with infectious complications, optimal sternal approximation during the initial procedure and sternal precautions during convalescence should be emphasized to prevent recurrent complications. [Copyright &y& Elsevier]

Background: Fear of transmission of donor organisms that may result in recipient pneumonia has a negative impact on donor lung utilization. We reviewed our experience with routine donor bronchial aspiration and culture at the time of transplantation to study the impact of donor bronchial organisms on the development of recipient post–lung transplant pneumonia (PTP) and other outcomes. Methods: We reviewed 80 consecutive single and bilateral lung transplants (SLTs and BLTs) from August 1998 to August 2001. Pediatric recipients and those not surviving >3 days were excluded. All donors met standard criteria for donor acceptance. All recipients received broad-spectrum antibiotics pending the results of final operating room cultures. PTP required clinical evidence (fever, leukocytosis and hypoxia), radiologic evidence (infiltrate), and culture confirmation during initial hospitalization or within 30 days. Results: Sixty-four donors for 71 recipients (39 SLTs, 32 BLTs) comprised the study population. Organisms were grown from 57 (89%) donors and 46 were polymicrobial. A total of 149 organisms were cultured consisting of 21 different species, with Staphylococcus (n = 35) and Streptococcus (n = 33) being the most common. PTP was seen in 31 (41%) recipients, with Pseudomonas species (n = 13) the most prevalent. Of the 71 donor–recipient pairs, 2 had both donor and recipient with no growth and PTP. The donor organisms had a sensitivity of 0.75 with a low specificity of 0.04 and were negatively correlated with development of PTP. PTP was an independent predictor of overall mortality. Conclusions: The presence of donor organisms does not predict PTP. Therefore, donor acceptance criteria need to be re-examined. [Copyright &y& Elsevier]

Objective: Because of limited medical and surgical options for patients with end-stage congestive heart failure, we expanded the criteria for surgical ventricular remodeling to include patients with multiterritory myocardial infarction, a group historically considered high-risk candidates. We present our series of patients with multiterritory myocardial infarction who underwent surgical ventricular remodeling and propose a new patient population who may benefit from this procedure. Methods: Data were analyzed for 51 consecutive patients undergoing surgical ventricular remodeling from January 2002 to June 2004, with 100% follow-up. Three left ventricular vascular territories were defined: anteroapicoseptal (left anterior descending), lateral (circumflex), and inferior (right coronary artery). Infarction was assessed with magnetic resonance imaging and intraoperative findings. Results: Multiterritory myocardial infarction was found in 64.7% of patients (33/51) undergoing surgical ventricular remodeling. Mean age was 61.6 ± 11.1 years (range 40-81 years). Sixty-one percent (20/33) demonstrated evidence of myocardial infarction in all three territories. Five patients underwent concomitant mitral valve repair or replacement. Operative mortality was 6.1% (2/33) and did not differ from that of patients with single-territory infarction (11.1%, P = .61). Surgical ventricular remodeling significantly improved left ventricular volumes and ejection fraction in patients with multiterritory myocardial infarction. Three patients required assist device implantation, and 2 patients required defibrillator placement. Sixty-nine percent of patients in preoperative New York Heart Association functional class III or IV (22/32) had improvement to class I or II at follow-up (P < .01). Cox regression analysis discriminated a preoperative left ventricular end-systolic volume index greater than 100 mL/m2 as a significant risk factor for mortality (odds ratio 12.1, 95% confidence interval 1.27-114.51, P = .03). Thirty-month survival of patients with multiterritory myocardial infarction (73.5% ± 8.3%) did not differ statistically from that of patients with single-territory infarction (n = 18). Conclusion: Surgical ventricular remodeling improves cardiac function and New York Heart Association functional status in patients with multiterritory myocardial infarction. Our initial results are promising and should prompt further studies to confirm our results and potentially expand the surgical ventricular remodeling inclusion criteria to include patients with multiterritory myocardial infarction. [Copyright &y& Elsevier]

Background: Continuous hypothermic perfusion is a novel cardiac preservation technique. Reactive oxygen species play a role in ischemia reperfusion injury and limit organ preservation. Oxidative stress mediates a DNA mismatch lesion (7, 8-dihydro-8-oxoguanine [8-oxo-G]), which is repaired by the enzymes MutY homologue (MYH), 8-oxo-G glycosylase (OGG1), and MutS homologue 2 (MSH2). We hypothesized that continuous hypothermic perfusion would allow for maintenance of cardiac function while attenuating myocardial DNA damage with respect to the current clinical practice of static preservation at 4°C. Methods: In our canine orthotopic transplant model, donor hearts were harvested after echocardiograms, and hemodynamic studies were obtained and served as controls. The hearts were transplanted after 24 hours of continuous hypothermic perfusion or 4 hours of static preservation, and were studied for 6 hours. Quantification of 8-oxo-G lesions, MYH, OGG1, and MSH2 concentrations were performed on biopsies using immunohistochemistry. Results: Postimplant echocardiograms, completed in 7 continuously perfused and 8 statically preserved hearts, demonstrated good function and normal wall motion. Positive staining for 8-oxoG was markedly increased in the static preservation group. Staining density for MYH, OGG1, and MSH2 were significantly decreased in statically preserved hearts and equivalent between continuously perfused and control hearts. Conclusions: The DNA damage assayed by 8-oxoG was significantly increased in statically preserved versus continuously perfused hearts. The DNA repair enzymes MYH, OGG1, and MSH2 were also markedly decreased in the static preservation versus continuous hypothermic perfusion groups. Continuous hypothermic perfusion reduces oxidative damage and extends preservation without compromising function. [Copyright &y& Elsevier]

Abstract: The antioxidant and antimicrobial efficacy of grape seed extract (GSE) was studied in restructured mutton slices (RMS) under aerobic and vacuum packaging conditions during refrigerated storage. The RMS treated with grape seed extract (GSE) had significantly (P<0.05) lower thiobarbituric acid reactive substance (TBARS) values and free fatty acids (FFA) % compared to control (C) and butylated hydroxy anisole (BHA) treated RMS during storage at 4±1°C. Addition of GSE significantly (P<0.05) reduced the total psychrophilic and coliform counts in RMS during refrigerated storage. The GSE treated mutton slices recorded significantly (P<0.05) superior scores of color, flavor, juiciness and overall palatability than C and BHA treated RMS. The TBARS values, FFA % and microbial counts increased significantly (P<0.05) during storage. It can be concluded that GSE has excellent antioxidant and antimicrobial properties compared to control and BHA treated RMS during refrigerated storage under aerobic and vacuum conditions. [Copyright &y& Elsevier]

Abstract: We evaluated the effectiveness of Anvirzel™, an aqueous extract of Nerium oleander on HIV infection of human peripheral blood mononuclear cells. Oleandrin, the principle cardiac glycoside (CG) in Anvirzel™ has been shown to exhibit anti-cancer properties but its efficacy against HIV is unknown. Treatment with Anvirzel™ significantly reduced the infectivity of virus produced from infected cells without any change in the total amount of virus produced. This is in contrast to treatment with AZT, a potent inhibitor of HIV replication that has been shown to significantly reduce virus production. Relative to untreated cultures, virus in cultures treated with oleandrin had significantly reduced expression of the envelope protein gp120, the sole determinant of virus infectivity, suggesting a novel mechanism underlying the impaired infectivity. These results support the potential utility of the Nerium oleander aqueous extract, containing the CG oleandrin as a novel candidate anti-HIV therapeutic. [Copyright &y& Elsevier]

Abstract: The E6 and E7 oncoproteins of the high-risk HPV type16 represent ideal targets for HPV vaccine development, they being consistently expressed in cervical cancer lesions. Since HPV-16 is primarily transmitted through genital mucosal route, mucosal immune responses constitute an essential feature for vaccination strategies against HPV-associated lesions. We present here evidence showing that mucosal immunization of mice by the intranasal route with a mixture of peptides E744–62 and E643–57 from the E7 and E6 oncoproteins of HPV-16, respectively, using a mutant cholera toxin adjuvant (CT-2*), primed strong antigen-specific cellular immune responses in systemic and mucosal tissues. Significant levels of IFN-γ production by both CD4 and CD8 cells were observed along with CTL responses that were effective against both peptide-pulsed targets as well as syngeneic tumor cells (TC-1) expressing the cognate E6 and E7 proteins. Furthermore, mice immunized with the peptide mixture and CT-2* effectively resisted TC-1 tumor challenge. These results together with our earlier observations that T cell responses to these peptides correlate with recurrence-free survival in women after ablative treatment for HPV-associated cervical intraepithelial neoplasia, support the potential of these E6 and E7 peptides for inclusion in vaccine formulations. [Copyright &y& Elsevier]