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Background: This study aimed to assess the accuracy of two-dimensional echocardiography (echo) in diagnosing unicuspid aortic valve (UAV) and to determine echo features that could improve the diagnosis. Method: We reviewed transthoracic/transesophageal echoes (TTE/TEE) from our hospital database for adult patients who had aortic valve surgery with a preoperative echo diagnosis of UAV or equivocal diagnosis of bicuspid aortic valve (BAV) BAV/UAV. Morphological characteristics of AV and ascending aortic dimensions were evaluated. Results: Nineteen patients were identified, 13 (11 Male, 2 Female, mean age 47 ± 10 years) had surgically confirmed diagnosis of UAV, six had BAV. The incidence of UAV was 2.6%. For diagnosing UAV, the sensitivity and specificity of TTE was 27% and 50% and those of TEE was 75% and 86%, respectively. For TTE, positive predictive value (PPV) was 60% and negative predictive value (NPV) was 20%. By TEE, PPV was 90% and the NPV was 67%. In UAV patients, 85% had severe aortic stenosis (mean gradient 45 ± 16 mmHg, AVA: 0.9 ± 0.2 cm). 46% had ascending aorta aneurysm (mean aortic root, sinutubular junction, ascending aorta dimensions: 36 ± 3 mm, 31 ± 4 mm and 41 ± 8 mm). Patients with ascending aortic aneurysm were younger (41 ± 11 years vs. 52 ± 5 years, P < 0.05) All UAV were unicommissural with a posteriorly positioned commissural attachment, 69% were heavily calcified. Diagnostic accuracy was limited by quality of images, severity, and distribution of calcification. Conclusion: TEE is the diagnostic modality of choice in UAV. Identifying several echo features may improve its diagnostic accuracy. (Echocardiography 2010;27:1107-1112) [ABSTRACT FROM AUTHOR]

The use of cardiopulmonary bypass (CPB) for locally advanced thoracic malignancies is highly controversial. The purpose of this study was to document the techniques and results of CPB to facilitate the resection of complex thoracic malignancies and to identify common themes that provided for successful outcomes. This was a retrospective study that took place from January 1992 to September 2002. Fourteen consecutive patients (median age, 59 years; age range, 18 to 69 years; seven men and seven women) underwent CPB during the resection of locally advanced thoracic malignancies at two Boston hospitals. CPB was planned in 8 of 14 patients (57%) with centrally located tumors, while 6 of 14 patients (43%) required emergent institution of CPB due to injury of the superior vena cava (2 patients), inferior vena cava (2 patients), or pulmonary artery (2 patients). Complete microscopic resection was achieved in 12 of 14 patients (86%). The operative mortality rate was 1 of 14 patients (7%) due to pulmonary embolism (ie, the elective group). The median ICU and hospital lengths of stay were 5 and 9 days, respectively. The overall 1-year, 3-year, and 5-year survival rates were 57%, 36%, and 21%, respectively. The planned use of CPB to facilitate complete resection of thoracic malignancies should be considered only after careful patient selection. The availability of CPB also provides a safety net in the event of injury to vascular structures during tumor resection. [ABSTRACT FROM AUTHOR]

Rhynchosia minima grown at Indian Institute of Pulses Research, Kanpur, India, showed yellow mosaic symptoms on leaves and were suspected to be caused by begomovirus(es). Leaves from five different plants (Rhm1-Rhm5) were tested for the presence of four viruses in PCR. PCR assays revealed the presence of mungbean yellow mosaic India virus in four samples, whereas one sample (Rhm2) was negative. Processing of Rhm2 sample using rolling circle amplification and restriction digestion indicated the presence of DNA molecules of ~ 2.6-2.7 kb. These molecules were sequenced after cloning and found to be of 2741 and 2658 nucleotides in size. BLAST analysis revealed that DNA-A (OQ269467) and DNA-B (OQ269468) molecules of rhynchosia yellow mosaic virus (RhYMV) with 99.09% and 93.74% nucleotide similarity with DNA-A (KP752090) and DNA-B (KP752091) of the RhYMV isolate, respectively. These sequences had a genome organization typical of legume-infecting Old World bipartite begomoviruses. Full genome sequences obtained from Rhm2 are, therefore, considered to be an isolate of RhYMV, designated as RhYMV-IN-Knp. The phylogenetic analysis revealed that RhYMV-IN-Knp was grouped with other isolates of RhYMV followed by Cajanus scarabaeoides yellow mosaic virus. DNA-A of RhYMV-IN-Knp showed two recombination events. The Old World bipartite begomovirus squash leaf curl China virus (AM260205) was identified as the major parent, whereas New World bipartite begomovirus rhynchosia golden yellow mosaic Yucatan virus (EU021216) was identified as the minor parent. RhYMV holds the potential of infecting cultivated legume crops, therefore regular monitoring is crucial especially for pigeonpea breeding programs., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In many regions across the world, including river basins, population growth and land development have enhanced the demand for land and other natural resources. The anthropogenic activities can be detrimental to the vital ecosystems that sustain the river basin region. This work assessed the impact of human modification on land surface temperature (LST) for the Ramganga basin in India. It has been hypothesised that the footprints of anthropogenic activities in the region have been connected to the LST fluctuation for the region, which could indicate environmental degradation. The LST variation between 2000 and 2016 has been estimated to test this hypothesis. The spatio-temporal correlation between human modification and LST has been computed. LST has been calculated with MODIS satellite data in the Google earth engine (GEE) platform, and anthropogenic activities can be visualised using an LU/LC map of the basin created by the Classification and Regression (CART) technique. The statistical parameters (average, maximum and standard deviation) of annual temperature for each pixel in 17 years (2000-2016) have been assessed to establish the links with human modification. The result of this work portrays a positive correlation of 0.705 between maximum LST and human modification. The forest class in the basin region has the lowest average human modification value (0.37), and it also possesses the lowest mean LST of 26.72 °C. Similarly, the settlement class has the highest average human modification value (0.85), and the mean LST temperature of this class has been on the higher side, having a value of 31.07 °C., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The fluctuation in the river ecosystem network due to climate change-induced global warming affects aquatic organisms, water quality, and other ecological processes. Assessment of climate change-induced global warming impacts on regional hydrological processes is vital for effective water resource management and planning. The global warming effect on river water quality has been analyzed in this work. The river Ganga stretch near the Varanasi region has been chosen as the study area for this analysis. The air temperature has been predicted using the seasonal autoregressive integrated moving average (SARIMA) and the Prophet model. The Prophet model has shown better accuracy with a root mean square percent error (RMSPE) value of 3.2% compared to the SARIMA model, which has an RMPSE value of 7.54%. The river temperature, turbidity, and nighttime radiance values have been predicted for the years 2022 and 2025 using the long short-term memory (LSTM) algorithm. The anthropogenic effect on the river has been evaluated by using the nighttime radiance imageries. The predicted average river temperature shows an increment of 0.58 °C and 0.63 °C for the city and non-city river stretches, respectively, in 2025 compared to 2022. Similarly, the river turbidity shows an increment of 1.21 nephelometric turbidity units (NTU) and 1.17 NTU for the city and non-city stretch, respectively, in 2025 compared to 2022. For future predicted years, the nighttime radiance values for the region situated near the city river stretch show a significant rise compared to the region that lies nearby the non-city river stretch., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

River Ganga is one of the most significant rivers in the country. This river is the adobe for numerous aquatic species and microorganisms. The color of the river suddenly changed to green due to the rise of algal bloom in the Varanasi and nearby regions of the river Ganga during May-June 2021. These algal blooms can be detrimental to the aquatic animals of the river. This study analyzes the occurrence and the possible reasons for the algal bloom generation in the river for the considered stretch. Several factors like nutrient accumulation in the river through agricultural run-off, warm river temperature, low flow condition of the river, thermal stratification, and less turbid river water can be considered as possible reasons for algal bloom development. In this work, the optical remote sensing-based Sentinel 2 datasets have been used for the duration of mid-May 2021 to mid-June 2021. These datasets have been processed in the Google Earth Engine (GEE) platform, and chlorophyll concentration has been calculated using different satellite-based indices or band ratios. The chlorophyll concentration measurements have quantified the algal bloom growth. These indices or band ratios have been analyzed using several artificial neural network (ANN) architectures like multilayer perceptron (MLP) and radial basis function (RBF) along with the in situ values. It has been found that chlorophyll concentration has been highest for the mid-June 2021 time period in the considered river stretch., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Due to unavailability of a specific drug/vaccine to attenuate severe acute respiratory syndrome coronavirus 2, the current strategy to combat the infection has been largely dependent upon the use of anti-inflammatory drugs to control cytokines storm responsible for respiratory depression. Thus, in this study, we discovered novel pyrazole analogs as a potent nuclear factor kappa B (NF-ĸB) inhibitor. The compounds were assessed for NF-ĸB transcriptional inhibitory activity in RAW264.7 cells after stimulation with lipopolysaccharides (LPS), revealing Compound 6c as the most potent analog among the tested series. The effect of Compound 6c was further investigated on the levels of interleukin-1β, tumor necrosis factor-α, and interleukin-6 in LPS-stimulated RAW267.4 cells by enzyme immunoassay, where it causes a significant reduction in the level of these cytokines. In Western blot analysis, Compound 6c also causes the inhibition of inhibitor kappa B-α and NF-κB. It was found to be snugly fitted into the inner grove of the active site of NF-ĸB by forming H-bonds and a nonbonded interaction with Asn28 in a docking analysis., (© 2020 Wiley Periodicals LLC.)

Parkinson's disease (PD) is a chronic neuro-degenerative ailment characterized by impairment in various motor and nonmotor functions of the body. In the past few years, adenosine A 2 A receptor (A 2 AR) antagonists have attracted much attention due to significant relief in PD. Therefore, in the current study, we intend to disclose the development of novel 1,3,5-triazines as A 2 AR antagonist. The radioligand binding and selectivity of analogs were tested in HEK293 (human embryonic kidney) and the cells were transfected with pcDNA 3.1(+) containing full-length human A 2 AR cDNA and pcDNA 3.1(+) containing full-length human A 1 R cDNA, where they exhibit selective affinity for A 2 AR. Molecular docking analysis was also conducted to rationalize the probable mode of action, binding affinity, and orientation of the most potent molecule (7c) at the active site of A 2 AR. It has been shown that compound 7c form numerous nonbonded interactions in the active site of A 2 AR by interacting with Ala59, Ala63, Ile80, Val84 Glu169, Phe168, Met270, and Ile274. The study revealed 1,3,5-triazines as a novel class of A 2 AR antagonists., (© 2020 Wiley Periodicals LLC.)

Various studies showed adenosine A 2 A receptors (A 2 ARs) antagonists have profound therapeutic efficacy in Parkinsons Disease (PD) by improving dopamine transmission, thus being active in reversing motor deficits and extrapyramidal symptoms related to the disease. Therefore, in the presents study, we have showed the development of novel 1,3,5-triazine-thiadiazole derivative as potent A 2 ARs antagonist. In the radioligand binding assay, these molecules showed excellent binding affinity with A 2 AR compared to A 1 R, with significant selectivity. Results suggest, compound 7e as most potent antagonist of A 2 AR among the tested series. In docking analysis with A 2 AR protein model, compound 7e found to be deeply buried into the cavity of receptor lined via making numerous interatomic contacts with His264, Tyr271, His278, Glu169, Ala63, Val84, Ile274, Met270, Phe169. Collectively, our study demonstrated 1,3,5-triazine-thiadiazole hybrid as a highly effective scaffold for the design of new A 2 A antagonists., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Remote sensing-based flood inundation mapping and monitoring is very crucial input before, during, and after floods. Ganga-Ramganga doab is one of the prolonged flood-affected area in middle Ganga plain due to seasonal monsoon which leads to rise in water levels of Ganga and Ramganga rivers. The focus of the present study is to map severe flood condition captured through synthetic aperture radar (SAR) data during August-September 2018, and to explain the impact on Ramganga river morphology. SAR data is preferred for flood mapping and real-time monitoring in all weather conditions. In this study, dual-polarized (VV and VH) Sentinel-1 SAR images coupled with hydrological data (river water level) were used to produce flood inundation maps. Thresholding technique has been applied to determine the flood mapping through Sentinel-1 data. VH and VV polarisation methods have been applied for a comparison of their respective accuracies in delineating surface water. Results have been validated against a Sentinel-2 optical image, and both polarisations produced a total accuracy of more than 93%. VV polarisation has high accuracies than VH polarisation as similar results are observed in previous studies as well. The finding reveals that severe bank erosion took place in the Ramganga channel which significantly affected the channel morphology, mainly the massive mobilisation of channel sediments. The results show that the average channel width increased from 46 to 336 m. The proposed approach demonstrates that the microwave remote sensing data along with GIS can be used efficiently for flood inundation mapping, monitoring, and analysing its effect on channel morphology. Therefore, the results of this study will help to take the initiative to reduce the flood hazard impact in the doab area and increase the flexibility in the process of flood management.

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.

Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

A disease of lentil with symptoms of distortion, mottling and chlorosis in the leaves, shortening of internodes and excessive branching was noticed in lentil at Kanpur, India, during 2012-2014. Results of polymerase chain reaction and reverse transcriptase polymerase chain reaction employed to detect suspected RNA and DNA viruses indicated involvement of a geminivirus, which was further characterized by sequencing of full genome amplified by rolling circle amplification. Analysis of full length DNA-A revealed 96.4-96.7% nucleotide similarity with bitter gourd yellow vein virus (BGYVV) isolates and tomato leaf curl New Delhi virus (ToLCNDV) isolate. As per the recent revision of begomovirus species demarcation criteria, if a new virus isolate shares ≥91% nt sequence identity with any other isolate of an existing species, it should be treated as an isolate of that species, even if it is <91% identical to all other isolates from that species. This made BGYVV an isolate of ToLCNDV and resulted in the de-recognizing of the BGGYV. Hence, the present virus has been named as a strain of ToLCNDV and designated as Tomato leaf curl New Delhi virus-Lentil-[India:Kanpur:Lentil:2014] with the acronym as ToLCNDV-Lentil-[IN:Knp:Len:14]. This is the first report of a begomovirus found associated with a disease in lentil from India.

Many studies have shown that the finger length ratios might be characteristic for sexual dimorphism. The aim of the study was to determine sexual dimorphism in finger length ratios among the representatives of the Indo-Mauritian population. The study group comprised of 200 healthy Indo-Mauritian people (100 male and 100 female) of the age ranged from 19 to 25 years. The lengths of second (2D), third (3D), forth (4D) and fifth (5D) finger of both hands were measured by using a vernier caliper. Our results indicate that all finger length ratios have significant sex differences (p-value < 0.05) except 2D:5D and 3D:5D. To conclude, 2D:4D ratio is the most decisive ratio (predictive accuracy = 0.61) which can demarcate between male and female., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Clinical right ventricular (RV) impairment can occur with left ventricular assist device (LVAD) use, thereby compromising the therapeutic effectiveness. The underlying mechanism of this RV failure may be related to induced abnormalities of septal wall motion, RV distension and ischemia, decreased LV filling, and aberrations of LVAD flow. Inhaled nitric oxide (NO), a potent pulmonary vasodilator, may reduce RV afterload, and thereby increase LV filling, LVAD flow, and cardiac output (CO). To investigate the mechanisms associated with LVAD-induced RV dysfunction and its treatment, we created a swine model of hypoxia-induced pulmonary hypertension and acute LVAD-induced RV failure and assessed the physiological effects of NO. Increased LVAD speed resulted in linear increases in LVAD flow until pulse pressure narrowed. Higher speeds induced flow instability, LV collapse, a precipitous fall of both LVAD flow and CO. Nitric oxide (20 ppm) treatment significantly increased the maximal achievable LVAD speed, LVAD flow, CO, and LV diameter. Nitric oxide resulted in decreased pulmonary vascular resistance and RV distension, increased RV ejection, promoted LV filling and improved LVAD performance. Inhaled NO may thus have broad utility for the management of biventricular disease managed by LVAD implantation through the effects of NO on LV and RV wall dynamics.

Postoperative atrial fibrillation (AF) is a serious yet common complication after coronary artery bypass grafting (CABG) surgery. Risk factors for postoperative AF have been identified, including echocardiographic parameters, and these are relied on to implement preventative strategies that reduce the incidence of AF. There has yet to be a study examining the impact of echocardiographic right-sided cardiac parameters on the prediction of postoperative AF. Thus, a panel of right-sided cardiac parameters was measured in a cohort of patients undergoing isolated CABG surgery, excluding those who did not have echocardiographic assessment within 30 days before surgery and those with any history of AF. The primary outcome was postoperative AF defined as any episode of AF requiring treatment during the index hospitalization. Postoperative AF occurred in 197 of 768 patients (25.6%); these were older and more likely to have hypertension and chronic kidney disease. After adjustment for clinical and echocardiographic variables, left atrial volume index ≥34 ml/m(2) (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.36 to 2.87), abnormal right ventricular myocardial performance index (OR 1.50, 95% CI 1.01 to 2.24), and advancing age (OR 1.05, 95% CI 1.03 to 1.07) were found to be independent predictors of postoperative AF. In conclusion, right ventricular myocardial performance index is a novel predictor of postoperative AF in patients undergoing isolated CABG surgery and appears to be additive to established risk factors such as age and left atrial volume., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: In this study, we aim to investigate the association between aortic sclerosis and mortality and major morbidity in patients with established coronary artery disease undergoing coronary artery bypass grafting (CABG)., Design: Preoperative echocardiograms of consecutive patients undergoing isolated CABG between 2007 and 2009 (n=1150) were analysed, excluding patients without an echocardiogram in the 30 days prior to surgery (n=483). Using logistic regression, we evaluated the association between aortic sclerosis and inhospital mortality and major morbidity. Using Cox proportional hazards, the effect on long-term all-cause mortality was determined., Setting: Massachusetts General Hospital, Boston., Patients: Patients undergoing isolated CABG between 2007 and 2009., Interventions: Analysis of echocardiograms., Main Outcome Measures: Inhospital mortality and major morbidity, and long-term all-cause mortality., Results: 627 patients were suitable for enrolment; 207 (33%) had significant aortic sclerosis. These patients had higher rates of traditional cardiovascular risk factors. Significant aortic sclerosis was associated with an increased risk of inhospital mortality or major morbidity (OR 1.95; 95% CI 1.25 to 3.04). Following adjustment for baseline clinical and echocardiographic variables, the association remained significant (OR 1.90; 95% CI 1.15 to 3.11). The HR for adjusted all-cause mortality was 2.52 (mean follow-up 2.7 years)., Conclusions: Aortic sclerosis is a common finding in patients undergoing CABG. In these patients, its presence is associated with a higher risk of inhospital mortality or major morbidity, and is associated with a higher risk of all-cause long-term mortality independent of other risk factors.

Background: Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram., Methods and Results: Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up., Conclusions: Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.

Introduction: Cardiac surgery demands effective teamwork for safe, high-quality care. The objective of this pilot study was to develop a comprehensive program to sharpen performance of experienced cardiac surgical teams in acute crisis management., Methods: We developed and implemented an educational program for cardiac surgery based on high realism acute crisis simulation scenarios and interactive whole-unit workshop. The impact of these interventions was assessed with postintervention questionnaires, preintervention and 6-month postintervention surveys, and structured interviews., Results: The realism of the acute crisis simulation scenarios gradually improved; most participants rated both the simulation and whole-unit workshop as very good or excellent. Repeat simulation training was recommended every 6 to 12 months by 82% of the participants. Participants of the interactive workshop identified 2 areas of highest priority: encouraging speaking up about critical information and interprofessional information sharing. They also stressed the importance of briefings, early communication of surgical plan, knowing members of the team, and continued simulation for practice. The pre/post survey response rates were 70% (55/79) and 66% (52/79), respectively. The concept of working as a team improved between surveys (P = .028), with a trend for improvement in gaining common understanding of the plan before a procedure (P = .075) and appropriate resolution of disagreements (P = .092). Interviewees reported that the training had a positive effect on their personal behaviors and patient care, including speaking up more readily and communicating more clearly., Conclusions: Comprehensive team training using simulation and a whole-unit interactive workshop can be successfully deployed for experienced cardiac surgery teams with demonstrable benefits in participant's perception of team performance., (Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Gender determination is an important aspect of personal identification, which is often required in medicolegal practice. Many experts believe that there are finer and more epidermal ridges on the fingers of women as compared with men. However, it is important to establish numerical cut-off values in terms of ridge counts to facilitate the gender determination within a particular population. The present study was conducted in the Department of Forensic Medicine, SSR Medical College, Mauritius with the objective to describe the ridge density in the Indo-Mauritian population and to devise a numerical model which is capable of identifying the sex of an individual from this population on the basis of the ridge counts obtained from the corresponding finger prints. The study was focused on 200 healthy medical students (100 men and 100 women) within the age range of 20-30 years. Multivariate analysis of variance results shows a significant gender difference in the sense that women tend to have higher ridge density then men in the distal region of all 10 digits (F = 41.83, P ≤ 0.005). The maximum mean ridge density over all fingers in men (12.26∼12) is less than the minimum mean ridge density over all fingers in women (12.71∼13). A linear discriminant function is derived from numerical modelling, which is used to predict (with a high reliability index, 0.92) the sex of the person whose fingerprints are obtained.

Quadricuspid aortic valve (QAV) is rare and its diagnosis, clinical course, and management are less well defined relative to other aortic valve abnormalities. Advances in diagnostic imaging, notably in ultrasound, have increased clinical awareness of this anomaly and prompted this review of our experience with 12 new patients and a compilation of previously reported patients to further characterize this condition., (© 2011, Wiley Periodicals, Inc.)

Determination of stature from fragmented human remains is vital part of forensic investigation for the purpose of identification. The present study was aimed to modelling the stature both for male and female separately on the basis of craniofacial dimensions. The study was conducted on 150 young and healthy students (75 males and 75 females) in the age group ranging from 20 to 28 years. The stature and fourteen cephalo-facial dimensions were measured on each subject by using standard anthropometric instruments. It is remarked that the stature and craniofacial measurements of males were significantly higher than that of females, except for nasal height where no significant difference was observed (p > 0.05). The correlation coefficients (r) of all cephalo-facial dimensions were less than 0.5. It means the estimation of stature is not reliable with the help of cephalo-facial dimensions., (Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Public and private organizations have called for increased transparency in reporting of outcomes data for hospitals and surgeons, including risk-adjusted coronary artery bypass graft surgery (CABG) mortality data. Limited information is available about how the public actually interprets these data., Methods: Four different graphical and tabular displays of CABG outcomes for surgeons, three of which were modeled on current state public reports, were shown to 337 adults. Each display contained data for 3 to 5 hypothetical surgeons. For each format, respondents were asked to choose which surgeon they would be most and least likely to choose based on the data. Additionally, they were asked questions about public reporting., Results: Accurate identification of best surgeon performance varied by display format, with a high of 66% on one display and a low of 16% on another. Only 6.4% identified the surgeon with the lowest risk mortality across all four displays. Respondents with at least some college education were significantly more likely to identify the surgeon with the lowest risk-adjusted mortality, compared with respondents having no college education (21% to 72% vs. 9% to 59%; p<0.01). In one display, the surgeon with the lowest risk-adjusted mortality was effectively penalized for taking on higher-risk patients; respondents tended to select the surgeon with the lowest-risk population but the highest risk-adjusted mortality. Overall, 82% of respondents said that access to these types of data would be "absolutely essential" or "very important" in choosing a surgeon., Conclusions: Comprehension by the public of risk-adjusted CABG outcomes is limited and varies by display format. Poorly constructed displays may have led to misinterpretation, with potential unintended adverse consequences such as risk aversion. Further work is needed to design displays that maximize accurate interpretation by the public and more clearly define the risk and benefit of public reporting of surgeon performance., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Heparin-induced thrombocytopenia (HIT) is associated with a high incidence of vein graft occlusion after cardiac surgery. When HIT is suspected during the post-operative period, current guideline recommends a direct thrombin inhibitor such as argatroban to be started immediately. The aim of this retrospective study was to evaluate the safety and efficacy of argatroban in the early period after cardiac surgery. All patients who received argatroban within 72 h after cardiac surgery from September 2005 to June 2009 from a single center were included. Patient demographics, pre-operative relevant history, intra-operative events and post-operative data were collected and analyzed. The primary endpoints were bleeding, thrombotic complication during or after argatroban administration, and in-hospital mortality. The study population comprised 31 patients administered argatroban within 72 h after cardiac surgery. Argatroban was started a mean of 1.7 days after surgery (median dose, 0.66 μg/kg/min; median duration, 5.9 days). Twenty patients (64.5%) experienced bleeding; episode driven entirely by the need for blood transfusion. No new thromboembolic complication occurred during or after argatroban infusion. One patient died from aspiration pneumonia. Compared to those without bleeding complications, patients who bled had longer operation times and increased use of intra-aortic balloon pump. However, argatroban therapy including the starting time, median dose, infusion duration, and activated partial thromboplastin times showed no difference between the two groups. In cardiac surgery patients with clinical suspicion of HIT, early postoperative use of argatroban seems well-tolerated and associated with a low risk of thrombotic events.

Background: In this study, we sought to characterize the outcomes after isolated coronary artery bypass grafting (CABG) in patients with a history of remote (≥14 days), and recent (<14 days), percutaneous coronary intervention (PCI)., Methods and Results: Patients with PCI within 5 years of CABG were identified among 12 591 primary isolated CABG reported in the mandatory Massachusetts Adult Cardiac Surgery Database. Patients were excluded if they were out-of-state (n=1043, 8%), had undergone primary PCI for acute myocardial infarction (n=401, 3%), had a PCI-CABG interval >5 years or unknown (n=136 and n=673, 1% and 5%). Patients with a history of remote and recent PCI were analyzed separately. Each CABG patient with PCI was matched to 3 patients without PCI using a propensity score. Outcomes were analyzed using generalized estimating equations and stratified proportional hazards models, with a mean follow-up of 4.1±1.2 years. There were 1117 CABG patients (9%) with prior PCI (n(remote)=823; n(recent)=294). In matched CABG patients with remote prior PCI, no differences were found in 30-day mortality (1.1% versus 1.5%; P=0.432), hospital morbidity (41% versus 40%; P=0.385) and overall survival (hazard ratio, [95% confidence interval] for death for prior PCI, 0.93 [0.74 to 1.18]; P=0.555). In matched CABG patients with recent prior PCI, hospital morbidity was higher (59% versus 45%; P<0.001), but no differences were found in 30-day mortality (3.5% versus 3.1%; P=0.754) and overall survival (HR, 1.18 [0.83 to 1.69]; P=0.353)., Conclusions: In patients undergoing CABG, remote prior PCI (≥14 days) was not associated with adverse outcomes at 30 days or during long-term follow-up.

Background: In 2003, a satellite cardiac surgery program (SAT) was implemented at an affiliated community hospital located in an area historically served by an academic medical center (AMC). This study assessed the financial consequences and the changes in case-mix that occurred at the AMC after SAT implementation., Methods: From June 2002 through December 2005, 4593 adult patients underwent cardiac operations at the AMC. Excluded were 400 patients operated on during the 4-month transition period after SAT implementation and 1210 patients living more than 35 miles from the AMC. Multivariable regression was used to compare changes in case-mix and propensity-score adjusted costs for AMC patients referred from SAT area (N(before/after =) 328/291) vs other patients (N(before/after =) 897/1467)., Results: The SAT area referral rate decreased by 55%. Compared with other patients, AMC patients referred from the SAT area showed a greater increase in age in the second period (p = 0.013). The nursing workload and adjusted mean costs increased more for patients from the SAT area (p = 0.015 and 0.014, respectively). The hospital margin decreased in the second period for both referral areas (p < 0.001). For the patient subgroup undergoing coronary artery bypass grafting, this hospital margin decrease was greater for SAT area patients (p = 0.017)., Conclusions: After implementation of SAT program, fewer patients of lower complexity came to the AMC from the SAT area, and there was a significant increase in nursing workload and costs. During this interval, hospital margin for cardiac operations decreased from both referral areas but decreased significantly more for coronary artery bypass graft patients from the SAT area., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Aortic dilation and dissection are well-recognized cardiac abnormalities in women with Turner syndrome (TS), although the underlying pathophysiology is not fully understood. We report on a 46-year-old Hispanic woman who was previously diagnosed with moyamoya disease on magnetic resonance imaging after a presentation with stroke-like symptoms. Her features were consistent with TS and chromosome analysis revealed mosaicism in which 17% of the cells showed a pseudoisodicentric Y chromosome: 45,X (25)/46,X psu idic (Y)(11.2) (5). A preceding screening transthoracic echocardiogram had shown a bicuspid aortic valve (BAV) with an aortic diameter of 3.2 cm; at the time of moyamoya diagnosis, the aorta was 3.5 cm with mild aortic stenosis and mild aortic regurgitation. Four years later, the patient had had an acute aortic dissection, Stanford type A, which was repaired successfully. This case report is the third individual with TS associated with moyamoya disease and the first associated with dissection. The small number of cases does not allow detailed analysis other than noting patient age (two older than 40 years), karyotype (two others associated with isochrome Xq), and associated cardiac risk factors (one with BAV). Although this may be a chance occurrence, we hypothesize that moyamoya disease could be a manifestation of the vasculopathy in TS.

Objective: We sought to assess early and late survival and cardiovascular-specific mortality after surgical repair of acute ascending aortic dissection and the effect of differences in surgical technique, patient characteristics, and preoperative diagnostic testing., Methods: Between 1979 and 2003, 195 consecutive patients underwent repair for acute ascending aortic dissection within 2 weeks of the onset of symptoms. Mean follow-up was 7.0 +/- 5.9 years (range, 0-26 years) and was 100% complete., Results: Patients were aged 62 +/- 15 years on average and were mostly male (66%) and hypertensive (69%). Risk of death early and late after the operation decreased over the study period, with hospital mortality decreasing from 21% to 4% when comparing the first and most recent quartiles (P = .007, chi(2) test for trend). At 1, 5, 10, and 20 years postoperatively, survival was 84%, 69%, 55%, and 30%, respectively, and freedom from cardiovascular death was 86%, 80%, 71%, and 51%, respectively. Additional independent risk factors for death were older age (P < .001), renal dysfunction (P < .003), syncope (P = .007), and peripheral vascular disease (P = .006). During the study period, echocardiographic and computed tomographic diagnostic imaging replaced routine aortic angiographic analysis, and operative techniques involved more frequent use of open distal anastomoses, retrograde cerebral perfusion, earlier restoration of antegrade perfusion, and a conservative approach to aortic arch repair. Freedom from reoperation on the aorta or aortic valve was 93% and 84% at 5 and 10 years, respectively., Conclusions: Early and late survival after repair of acute ascending aortic dissection has improved progressively over 25 years in association with noticeable changes in preoperative and intraoperative management. Aortic reoperations were infrequent during follow-up.

Background: Atheroemboli caused by aortic manipulation poses a risk for stroke in patients undergoing cardiopulmonary bypass (CPB) surgery. One potential cause is the high velocity jet from aortic perfusion cannulae. This study describes the flow patterns of a novel funnel-tip cannula designed to reduce emboli by decreasing fluid velocity and resultant shear force on the aortic wall., Methods: A funnel-tip cannula was constructed and compared with standard straight-tip cannulae and the Dispersion (Research Medical Inc, Midvale, UT) and Sarns Soft Flow (Terumo Cardiovascular Systems Corp, Ann Arbor, MI) cannulae. Pressure drop measurements were collected at 1 to 6 L/minute flows. Velocity flow profiles were created using phase contrast magnetic resonance imaging. Absolute velocity was measured in a phantom aorta at 5 L/minute flow. Each cannula was further studied in a synthetic model of an atherosclerotic aorta to determine the mass of dislodged particulate matter generated at 2, 3, and 5 L/minute flows., Results: The funnel-tip cannula demonstrated significantly lower values (p < 0.05) in pressure drop (55 mm Hg), exit velocity (309 cm/second, 167 cm/second for center axis and wall, respectively), and particulate dislodgement (0.15 +/- 0.05 g) than other tested cannulae. The Soft Flow cannula generated the next lowest pressure drop but exhibited twice the exit velocity and particulate dislodgement of the funnel-tip cannula. The Dispersion cannula did not demonstrate a reduction in velocity or particulate dislodgement compared with the standard straight-tip cannulae., Conclusions: The results of this study suggest that a low-angled funnel-tip cannula has favorable flow characteristics warranting further investigation. Design development may reduce the risk of atheroemboli generation during CPB surgery.

Stature estimation from percutaneous body measurements forms part of forensic anthropological analysis for the purpose of identification. This study is aimed at modeling the stature on the basis of percutaneous tibial and/or ulnar length in human subjects comprising of Indo-Mauritian population. The study was conducted in the Department of Forensic Medicine and Toxicology, SSR Medical College, Mauritius on 180 young and healthy students comprising of 90 males and 90 females in the age group ranging from 18 to 28 years. The measurements were taken by using standard anthropometric instruments. It is remarked that tibial as well as ulnar length show a linear relationship with the stature, where stature is normally distributed. However, it is required to transform the measurements on stature to obtain appropriate regression equations. Moreover, since ulna and tibia are significantly correlated, it is recommended to use the sum of the ulnar and tibial length to estimate stature, in case both are available for an individual. Our regression models are sufficiently validated and highly efficient.

Background: Few studies of learning in the health care sector have analyzed measures of process, as opposed to outcomes. We assessed the learning curve for a new cardiac surgical center using precursor events (incidents or circumstances required for the occurrence of adverse outcomes)., Methods: Intraoperative precursor events were recorded prospectively during major adult cardiac operations, categorized by blinded adjudicators, and counted for each case (overall and according to these categories). Trends in the number of precursor events were analyzed by hospital and by defining 10 equal-sized groups across time, as were trends in outcomes obtained from institutional databases. Results from the first 101 cases performed at a new cardiac surgical site (hospital A) were compared with 2 established centers., Results: A steep reduction in the total number of precursor events over time was observed in the early experience of hospital A (9.2 +/- 4.9 to 2.0 +/- 1.2 events per case, from first to last decile of time, P(trend) < .0001) compared with qualitatively stable levels in the other hospitals; this reduction was driven largely by decreases in the minor severity (P(trend) < .0001), compensated (P(trend) < .0001), and environment (P(trend) < .0001) categories of precursor events. No detectable changes over time were observed in postoperative mortality and complications. No significant improvement was observed in patient comorbid conditions or medical status over time to explain the trend in hospital A., Conclusion: Analyzing and targeting specific kinds of process-related failures (precursor events) may provide a novel and sensitive means of tracking, deconstructing, and optimizing organizational learning in medicine.

In this study, an attempt was made to find out possible correlations between hand dimensions and stature using linear and curvilinear regression models for both genders. The study was conducted amongst 250 medical students (125 male and 125 female) aged 18-30 years. Each student has been studied for measurements of stature, hand length and hand breadth. To explain stature, all the explanatory variables like age, sex, hand length (right and left) and hand breadth (right and left) were included for model generation using SPSS. A general linear regression model was found to be best explanatory in both males and females, however, amongst the curvilinear models; the exponential model emerged as the 'best' in explaining stature of the individual. Left hand length alone explained very significantly (P<0.001).

Background: Concomitant mitral regurgitation (MR) is frequently seen in patients undergoing aortic valve replacement (AVR) for aortic stenosis. This study was undertaken to characterize the magnitude of MR in these patients and identify factors associated with significant postoperative change., Methods: Between 2002 and 2006, 391 patients with stenotic AV disease but no structural mitral valve disease underwent AVR without coronary artery bypass grafting. Excluded were 164 patients with combined aortic and mitral intervention, right heart surgery, or moderate to severe aortic insufficiency, to yield a final study group of 227 patients. Follow-up echographic evaluation of MR was obtained in 87 of 219 patients (40%) discharged alive without mitral valve intervention., Results: Overall mortality was 3.5%. After AVR, intraoperative MR severity improved in 66% of patients. Independent predictors of lower postoperative MR were small left atrial size (p = 0.03), the presence of aortic insufficiency (p < 0.01), and preoperative congestive heart failure (p = 0.04). Prosthetic valve type or size was not an independent predictor of postoperative MR. After adjustment for intraoperative underestimation of MR grade, there was no difference between the postprocedural MR grade and the early or late follow-up MR grade (p = 0.6 and p = 0.8, respectively)., Conclusions: The results of this study support a conservative, tailored approach to concomitant mitral surgery in patients presenting for correction of aortic stenosis who demonstrate functional mitral regurgitation. Characteristics associated with resolution may allow for identification of patients most likely to benefit from mitral valve repair or replacement.

The aim of this study was to develop a relationship between foot length and stature using linear and curvilinear regression models. Measurements of foot length and stature were taken from 250 medical students (125 males and 125 females) aged 18-30 years. General multiple linear regression model was highly significant (P<0.001) and validated with highest values for the coefficients of determination R(2)=0.769 and multiple correlation coefficient r=0.877. Right foot length, sex and age explained for about 77% variations in stature.