Search

Atmospheric radon measurements assist in many aspects of climate and meteorological research, notably as an airmass tracer and for modelling boundary layer development, mixing heights and stability. Daughter products from radon decay are sometimes incorporated into the particle pollution measurements of commercially available beta-attenuation monitors (BAM). BAMs incorporating radon measurements are used in air quality monitoring networks and can supplement traditional radon measurements. Here we compare in-situ radon measurements from Thermo Fisher Scientific (Franklin, MA, USA) BAM instruments (Thermo Scientific 5014i, Thermo Scientific 5030 SHARP, Thermo Anderson FH62C14) at two air quality monitoring stations in New South Wales, Australia. Between systems we find strong correlations for hourly measurements (r = 0.97–0.99); daily means (r = 0.97–0.99); hour of the day (r = 0.84–0.98); and month (r = 0.82–0.98). The regression analysis for radon measurements between systems showed strong linear responses, although there are some variations in the slopes of the regressions. This implies that with correction BAM measurements can be comparable to standard measurement techniques, for example, from the Australian Nuclear Science and Technology Organisation (ANSTO) dual flow loop monitors. Our findings imply that BAM derived radon measurements are precise, although their accuracy varies. BAM radon measurements can support studies on boundary layer development or where radon is used as an atmospheric transport tracer.

IntroductionSouth Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients.MethodThe UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed.ResultsOf the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, PConclusionStroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.

The emission of black carbon (BC) particles, which cause atmospheric warming by affecting radiation budget in the atmosphere, is the result of an incomplete combustion process of organic materials. The recent wildfire event during the summer 2019–2020 in south-eastern Australia was unprecedented in scale. The wildfires lasted for nearly 3 months over large areas of the two most populated states of New South Wales and Victoria. This study on the emission and dispersion of BC emitted from the biomass burnings of the wildfires using the Weather Research Forecast–Chemistry (WRF–Chem) model aims to determine the extent of BC spatial dispersion and ground concentration distribution and the effect of BC on air quality and radiative transfer at the top of the atmosphere, the atmosphere and on the ground. The predicted aerosol concentration and AOD are compared with the observed data using the New South Wales Department of Planning and Environment (DPE) aethalometer and air quality network and remote sensing data. The BC concentration as predicted from the WRF–Chem model, is in general, less than the observed data as measured using the aethalometer monitoring network, but the spatial pattern corresponds well, and the correlation is relatively high. The total BC emission into the atmosphere during the event and the effect on radiation budget were also estimated. This study shows that the summer 2019–2020 wildfires affect not only the air quality and health impact on the east coast of Australia but also short-term weather in the region via aerosol interactions with radiation and clouds.

Biomass burnings either due to Hazards Reduction Burnings (HRBs) in late autumn and early winter or bushfires during summer periods in various part of the world (e.g., CA, USA or New South Wales, Australia) emit large amount of gaseous pollutants and aerosols. The emissions, under favourable meteorological conditions, can cause elevated atmospheric particulate concentrations in metropolitan areas and beyond. One of the pollutants of concern is black carbon (BC), which is a component of aerosol particles. BC is harmful to health and acts as a radiative forcing agent in increasing the global warming due to its light absorption properties. Remote sensing data from satellites have becoming increasingly available for research, and these provide rich datasets available on global and local scale as well as in situ aethalometer measurements allow researchers to study the emission and dispersion pattern of BC from anthropogenic and natural sources. The Department of Planning, Industry and Environment (DPIE) in New South Wales (NSW) has installed recently from 2014 to 2019 a total of nine aethalometers to measure BC in its state-wide air quality network to determine the source contribution of BC and PM2.5 (particulate Matter less than 2.5 μm in diameter) in ambient air from biomass burning and anthropogenic combustion sources. This study analysed the characteristics of spatial and temporal patterns of black carbon (BC) in New South Wales and in the Greater Metropolitan Region (GMR) of Sydney, Australia, by using these data sources as well as the trajectory HYSPLIT (Hybrid Single Particle Lagrangian Integrated Trajectory) modelling tool to determine the source of high BC concentration detected at these sites. The emission characteristics of BC in relation to PM2.5 is dependent on the emission source and is analysed using regression analysis of BC with PM2.5 time series at the receptor site for winter and summer periods. The results show that, during the winter, correlation between BC and PM2.5 is found at nearly all sites while little or no correlation is detected during the summer period. Traffic vehicle emission is the main BC emission source identified in the urban areas but was less so in the regional sites where biomass burnings/wood heating is the dominant source in winter. The BC diurnal patterns at all sites were strongly influenced by meteorology.

There is increasing awareness in Australia of the health impacts of poor air quality. A common public concern raised at a number of “roadshow„ events as part of the federally funded Clean Air and Urban Landscapes Hub (CAUL) project was whether or not the air quality monitoring network around Sydney was sampling air representative of typical suburban settings. In order to investigate this concern, ambient air quality measurements were made on the roof of a two-storey building in the Sydney suburb of Auburn, to simulate a typical suburban balcony site. Measurements were also taken at a busy roadside and these are discussed in a companion paper (Part 2). Measurements made at the balcony site were compared to data from three proximate regulatory air quality monitoring stations: Chullora, Liverpool and Prospect. During the 16-month measurement campaign, observations of carbon monoxide, oxides of nitrogen, ozone and particulate matter less than 2.5-µm diameter at the simulated urban balcony site were comparable to those at the closest permanent air quality stations. Despite the Auburn site experiencing 10% higher average carbon monoxide amounts than any of the permanent air quality monitoring sites, the oxides of nitrogen were within the range of the permanent sites and the pollutants of greatest concern within Sydney (PM2.5 and ozone) were both lowest at Auburn. Similar diurnal and seasonal cycles were observed between all sites, suggesting common pollutant sources and mechanisms. Therefore, it is concluded that the existing air quality network provides a good representation of typical pollution levels at the Auburn “balcony„ site.

The unicellular parasite Giardia duodenalis is the causative agent of giardiasis, a gastrointestinal disease with global spread. In its trophozoite form, G. duodenalis can adhere to the human intestinal epithelium and a variety of other, artificial surfaces. Its attachment is facilitated by a unique microtubule-based attachment organelle, the so-called ventral disc. The mechanical function of the ventral disc, however, is still debated. Earlier studies postulated that a dynamic negative pressure under the ventral disc, generated by persistently beating flagella, mediates the attachment. Later studies suggested a suction model based on structural changes of the ventral discs, substrate clutching or grasping, or unspecific contact forces. In this study, we aim to contribute to the understanding of G. duodenalis attachment by investigating detachment characteristics and determining adhesion forces of single trophozoites on a smooth glass surface (RMS = 1.1 ± 0.2 nm) by fluidic force microscopy (FluidFM)-based single-cell force spectroscopy (SCFS). Briefly, viable adherent trophozoites were approached with a FluidFM micropipette, immobilized to the micropipette aperture by negative pressure, and detached from the surface by micropipette retraction while retract force curves were recorded. These force curves displayed novel and so far undescribed characteristics for a microorganism, namely, gradual force increase on the pulled trophozoite, with localization of adhesion force shortly before cell detachment length. Respective adhesion forces reached 7.7 ± 4.2 nN at 1 μm s -1 pulling speed. Importantly, this unique force pattern was different from that of other eukaryotic cells such as Candida albicans or oral keratinocytes, considered for comparison in this study. The latter both displayed a force pattern with force peaks of different values or force plateaus (for keratinocytes) indicative of breakage of molecular bonds of cell-anchored classes of adhesion molecules or membrane components. Furthermore, the attachment mode of G. duodenalis trophozoites was mechanically resilient to tensile forces, when the pulling speeds were raised up to 10 μm s -1 and adhesion forces increased to 28.7 ± 10.5 nN. Taken together, comparative SCSF revealed novel and unique retract force curve characteristics for attached G. duodenalis , suggesting a ligand-independent suction mechanism, that differ from those of other well described eukaryotes.

Background: Diabetes mellitus and central obesity are more common among South Asian populations than among White British people. This study explores the differences in diabetes and obesity in South Asians with stroke living in the United Kingdom, India, and Qatar compared with White British stroke patients., Methods: The study included the UK, Indian, and Qatari arms of the ongoing large Bio-Repository of DNA in Stroke (BRAINS) international prospective hospital-based study for South Asian stroke. BRAINS includes 4580 South Asian and White British recruits from UK, Indian, and Qatar sites with first-ever ischemic stroke., Results: The study population comprises 1751 White British (WB) UK residents, 1165 British South Asians (BSA), 1096 South Asians in India (ISA), and 568 South Asians in Qatar (QSA). ISA, BSA, and QSA South Asians suffered from higher prevalence of diabetes compared with WB by 14.5% (ISA: 95% confidence interval (CI) = 18.6-33.0, p  < 0.001), 31.7% (BSA: 95% CI = 35.1-50.2, p  < 0.001), and 32.7% (QSA: 95% CI = 28.1-37.3, p  < 0.001), respectively. Although WB had the highest prevalence of body mass index (BMI) above 27 kg/m 2 compared with South Asian patients (37% vs 21%, p  < 0.001), South Asian patients had a higher waist circumference than WB (94.8 cm vs 90.8 cm, p  < 0.001). Adjusting for traditional stroke risk factors, ISA, BSA, and QSA continued to display an increased risk of diabetes compared with WB by 3.28 (95% CI: 2.53-4.25, p  < 0.001), 3.61 (95% CI: 2.90-4.51, p  < 0.001), and 5.24 (95% CI: 3.93-7.00, p  < 0.001), respectively., Conclusion: South Asian ischemic stroke patients living in Britain and Qatar have a near 3.5-fold risk of diabetes compared with White British stroke patients. Their body composition may partly help explain that increased risk. These findings have important implications for public health policymakers in nations with large South Asian populations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ambient PM 2.5 (particles less than 2.5 μm in diameter) is monitored in many countries including Australia. Occasionally PM 2.5 instruments may report negative measurements, although in realty the ambient air can never contain negative amounts of particles. Some negative readings are caused by instrument faults or procedural errors, thus can be simply invalidated from air quality reporting. There are occasions, however, when negative readings occur due to other factors including technological or procedural limitations. Treatment of such negative data requires consideration of factors such as measurement uncertainty, instrument noise and risk for significant bias in air quality reporting. There is very limited documentation on handling negative PM 2.5 data in the literature. This paper demonstrates how a threshold is determined for controlling negative hourly PM 2.5 readings in the New South Wales (NSW) air quality data system. The investigation involved a review of thresholds used in different data systems and an assessment of instrument measurement uncertainties, zero air test data and impacts on key reporting statistics when applying different thresholds to historical datasets. The results show that a threshold of -10.0 μg/m 3 appears optimal for controlling negative PM 2.5 data in public reporting. This choice is consistent with the measurement uncertainty estimates and the zero air test data statistics calculated for the NSW Air Quality Monitoring Network, and is expected not to have significant impacts on key compliance reporting statistics such as data availability and annual average pollution levels. The analysis can be useful for air quality monitoring in other Australian jurisdictions or wider context., (© 2023. The Author(s).)

The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.

The N losses and agronomic performances of newly developed slow-releasing fertilisers (SRFs; Epox5 and Poly5) were tested against conventional N fertilisers, urea and diammonium phosphate (DAP), in a climate-controlled lysimeter system. The dry matter (DM) yield and N losses of SRFs were not significantly different from urea and DAP. However, nitrate leaching and nitrous oxide (N 2 O) losses were unexpectedly low and therefore, it was inferred that nitrate underwent a chemical transformation. It was observed that a thick fibreglass wick interrupted drainage and created an anaerobic condition in the soil. The subsoil was found to have a high extractable total iron and it was postulated that iron played a role in the observed low level of N losses. An investigation was carried out with a factorial design using sand types and rates of N application as the main factors. Two types of sand; with high and low iron concentration and four levels of N applications; 0 (control), 50, 100 and 200 kg N ha -1 were employed in a leaching column and nitrate and N 2 O losses were measured. The nitrate leaching was significantly (P < 0.05) affected by sand types wherein a lower nitrate level was recorded for high‑iron concentration sand than for low-iron concentration sand at all N application levels. The N 2 O emission was significantly (P < 0.05) lower for high-iron sand than for low-iron sand for the 200 N treatment, but not significantly different between sand types for other treatments. These observations provide evidence for the involvement of iron in nitrate transformation under anaerobic conditions and it was hypothesised path was dissimilar nitrate reduction (DNR). Further studies are recommended, to identify the underlying mechanism responsible for nitrate reduction with iron-rich sand., Competing Interests: Declaration of competing interest Authors have declared that they have no potential conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background and Purpose: Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients., Methods: We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India., Results: Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3 [22] years vs. ISA 52.0 [18] years vs. WB 71.5 [19] years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset., Conclusion: Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

The effect of newly developed controlled-release fertilisers (CRFs); Epox5 and Ver-1 and two levels of Fe2+ applications (478 and 239 kg-FeSO4 ha−1) on controlling nitrogen (N) losses, were tested on ryegrass, in a climate-controlled lysimeter system. The Epox5 and Ver-1 effectively decreased the total N losses by 37 and 47%, respectively, compared to urea. Nitrous oxide (N2O) emissions by Ver-1 were comparable to urea. However, Epox5 showed significantly higher (p < 0.05) N2O emissions (0.5 kg-N ha−1), compared to other treatments, possibly due to the lock-off nitrogen in Epox5. The application of Fe2+ did not show a significant effect in controlling the N leaching loss and N2O emission. Therefore, a dissimilatory nitrate reduction and chemodenitrification pathways were not pronounced in this study. The total dry matter yield, N accumulation, N use efficiency and soil residual N were not significantly different among any N treatments. Nevertheless, the N accumulation of CRFs was lower in the first month, possibly due to the slow release of urea. The total root biomass was significantly (p < 0.05) lower for Epox5 (35%), compared to urea. The hierarchical clustering of all treatments revealed that Ver-1 outperformed other treatments, followed by Epox5. Further studies are merited to identify the potential of Fe2+ as a controlling agent for N losses.

Background: Paediatric traumatic elbow dislocation occurs in 6 per 100,000 children per year and if not treated promptly can result in a poor outcome. Despite this, the long-term clinical and functional outcome of these injuries has not been well described using modern patient-reported outcome tools. The aim of our study was present the outcome of these injuries in the long term., Methods: Twenty children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016 were included in our study. Patient demographics, management and complications were recorded from the clinical notes. Ten children had associated fractures and were managed surgically, while the remaining were managed with closed reduction and immobilisation. Functional outcomes were assessed with Kim's elbow performance score., Results: The mean age was 12 years (7 -15) and follow-up was 8 years (4 - 13). There was one (5%) re-dislocation requiring surgery and one (5%) ulna nerve neurapraxia that resolved within one month. The average Kim's scores were 87.5 (65 - 100) and 77.5 (60 - 100) in the closed reduction and open reduction groups, respectively (P=0.08). 80% (16/20) reported good or excellent outcome with a Kim's score of greater than 75 points with no cases of poor functional outcome reported in our series., Conclusions: Traumatic elbow dislocations in children, with or without associated fracture, have a good long-term functional outcome with appropriate early management., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Research into materials for medical application draws inspiration from naturally occurring or synthesized surfaces, just like many other research directions. For medical application of materials, particular attention has to be paid to biocompatibility, osseointegration, and bacterial adhesion behavior. To understand their properties and behavior, experimental studies with natural materials such as teeth are strongly required. The results, however, may be highly case-dependent because natural surfaces have the disadvantage of being subject to wide variations, for instance in their chemical composition, structure, morphology, roughness, and porosity. A synthetic surface which mimics enamel in its performance with respect to bacterial adhesion and biocompatibility would, therefore, facilitate systematic studies much better. In this study, we discuss the possibility of using hydroxyapatite (HAp) pellets to simulate the surfaces of teeth and show the possibility and limitations of using a model surface. We performed single-cell force spectroscopy with single Staphylococcus aureus cells to measure adhesion-related parameters such as adhesion force and rupture length of cell wall proteins binding to HAp and enamel. We also examine the influence of blood plasma and saliva on the adhesion properties of S. aureus . The results of these measurements are matched to water wettability, elemental composition of the samples, and the change in the macromolecules adsorbed over time on the surface. We found that the adhesion properties of S. aureus were similar on HAp and enamel samples under all conditions: Significant decreases in adhesion strength were found equally in the presence of saliva or blood plasma on both surfaces. We therefore conclude that HAp pellets are a good alternative for natural dental material. This is especially true when slight variations in the physicochemical properties of the natural materials may affect the experimental series.

The management of elbow fracture-dislocations is challenging. The internal joint stabiliser (IJS) (Skeletal Dynamics, Miami, FL) has been advocated as an alternative to traditional techniques. This article shares our initial clinical experience and provide a systematic review analysing the ability of the IJS to maintain radiographic joint reduction and the associated complication profile. Two cases of elbow fracture-dislocations treated at our centre using the IJS are presented. A systematic review of the literature was conducted using the online databases Medline, Scopus and EMBASE. Clinical studies reporting the maintenance of joint reduction after the use of IJS in patients with acute or chronic elbow instability were included. The two cases reported remained radiographically concentric at 6 months follow up without complications. 5 studies met the inclusion criteria and were included in the systematic review (total n=65). Only two patients across the studies had ongoing radiological instability (3%) and both were associated with coronoid insufficiency. The mean flexion-extension arc ranged from 106° to 135° and pronation- supination arc ranged from 138° to 151°. The mean DASH scores ranged from 16 to 37.3 and the mean Broberg and Morrey Functional score from 68.2 to 93. Complication rates in the case series ranged from 21% to 40%, the commonest complications were heterotopic ossification, neuropathy and infections. Initial reports into the use of the Internal Joint Stabiliser for elbow instability have shown a low incidence of residual radiological joint incongruency.

Caries is one of the most prevalent diseases worldwide, which is caused by the degradation of the tooth enamel surface. In earlier research the opportunistic pathogen Candida albicans has been associated with the formation of caries in children. Colonization of teeth by C. albicans starts with the initial adhesion of individual yeast cells to the tooth enamel surface. In this study, we visualized the initial colonization of C. albicans yeast cells on pellicle-covered enamel by scanning electron microscopy. To quantitatively unravel the initial adhesion strength, we applied fluidic force microscopy-based single-cell force spectroscopy to examine the key adhesion parameters adhesion force, rupture length and de-adhesion work. We analyzed single saliva-treated or untreated yeast cells on tooth enamel specimens with or without salivary pellicle. Under all tested conditions, adhesion forces in the lower nanonewton range were determined. Furthermore, we have found that all adhesion parameters were enhanced on the pellicle-covered compared to the uncovered enamel. Our data suggest that initial adhesion occurs through a strong interaction between yeast cell wall-associated adhesins and the salivary pellicle. Future SCFS studies may show whether specific management of the salivary pellicle reduces the adhesion of C. albicans on teeth and thus contributes to caries prophylaxis.

Introduction: Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice., Methods and Analysis: UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery., Ethics and Dissemination: A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication., Trial Registration Number: ISRCTN13930454., Competing Interests: Competing interests: LV was a member of the NIHR Health Technology Assessment Clinical Evaluation and Trials Panel from 2015 to 2018., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Staphylococcus aureus is a common cause of catheter-related blood stream infections (CRBSI). The bacterium has the ability to form multilayered biofilms on implanted material, which usually requires the removal of the implanted medical device. A first major step of this biofilm formation is the initial adhesion of the bacterium to the artificial surface. Here, we used single-cell force spectroscopy (SCFS) to study the initial adhesion of S. aureus to central venous catheters (CVCs). SCFS performed with S. aureus on the surfaces of naïve CVCs produced comparable maximum adhesion forces on three types of CVCs in the low nN range (~ 2-7 nN). These values were drastically reduced, when CVC surfaces were preincubated with human blood plasma or human serum albumin, and similar reductions were observed when S. aureus cells were probed with freshly explanted CVCs withdrawn from patients without CRBSI. These findings indicate that the initial adhesion capacity of S. aureus to CVC tubing is markedly reduced, once the CVC is inserted into the vein, and that the risk of contamination of the CVC tubing by S. aureus during the insertion process might be reduced by a preconditioning of the CVC surface with blood plasma or serum albumin.

Candida albicans -related bloodstream infections are often associated with infected central venous catheters (CVC) triggered by microbial adhesion and biofilm formation. We utilized single-cell force spectroscopy (SCFS) and flow chamber models to investigate the adhesion behavior of C. albicans yeast cells and germinated cells to naïve and human blood plasma (HBP)-coated CVC tubing. Germinated cells demonstrated up to 56.8-fold increased adhesion forces to CVC surfaces when compared to yeast cells. Coating of CVCs with HBP significantly increased the adhesion of 60-min germinated cells but not of yeast cells and 30-min germinated cells. Under flow conditions comparable to those in major human veins, germinated cells displayed a flow directional-orientated adhesion pattern to HBP-coated CVC material, suggesting the germ tip to serve as the major adhesive region. None of the above-reported phenotypes were observed with germinated cells of an als3 Δ deletion mutant, which displayed similar adhesion forces to CVC surfaces as the isogenic yeast cells. Germinated cells of the als3 Δ mutant also lacked a clear flow directional-orientated adhesion pattern on HBP-coated CVC material, indicating a central role for Als3 in the adhesion of germinated C. albicans cells to blood exposed CVC surfaces. In the common model of C. albicans , biofilm formation is thought to be mediated primarily by yeast cells, followed by surface-triggered the formation of hyphae. We suggest an extension of this model in which C. albicans germ tubes promote the initial adhesion to blood-exposed implanted medical devices via the germ tube-associated adhesion protein Als3.

Objective: To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS)., Methods: A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript., Results: Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates., Conclusion: Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid- and long-term morbidity and mortality rates associated with both techniques., (© 2020 Wiley Periodicals LLC.)

Purpose: The purpose of this study was to analyze the concentration-dependent effects of biguanides (polyhexamethylene biguanide [PHMB], chlorhexidine [CH]); diamidines (hexamidine-diisethionate [HD], propamidine-isethionate [PD], dibromopropamidine-diisethionate [DD]); natamycin (NM); miltefosine (MF); povidone iodine (PVPI), and chlorin e6 PDT on Acanthamoeba trophozoites and cysts, in vitro., Methods: Strain 1BU was cultured in peptone-yeast extract-glucose medium. Trophozoites or cysts were cultured in PYG medium containing each agent at 100%, 50%, and 25% of maximum concentration for 2 hours. The percentage of dead trophozoites was determined using a non-radioactive cytotoxicity assay and trypan blue staining. Treated cysts were also maintained on non-nutrient agar Escherichia coli ( E. coli ) plates and observed for 3 weeks., Results: All tested drugs displayed significant cytotoxic effects on 1BU cells based on the biochemical and staining-based viability assays tested. On non-nutrient agar E. coli plates, neither trophozoites nor freshly formed cysts were observed after PHMB, PD, NM, and PVPI treatment, respectively, within 3 weeks. However, CH-, HD-, DD-, and MF-treated cysts could excyst, multiply, and encyst again., Conclusions: The off-label drugs PHMB, PD, NM, and PVPI are under in vitro conditions more effective against strain 1BU than CH, HD, DD, and MF. Our findings also suggest that the non-nutrient agar E. coli plate assay should be considered as method of choice for the in vitro analysis of the treatment efficacy of anti-amoebic agents., Translational Relevance: Ophthalmologists may optimize the treatment regime against Acanthamoeba keratitis by pre-testing the in vitro susceptibilities of the Acanthamoeba strain against drugs of interest with the non-nutrient E. coli agar plate assay., Competing Interests: Disclosure: L. Shi, None; V. Muthukumar, None; T. Stachon, None; L. Latta, None; M.I. Elhawy, None; G. Gunaratnam, None; E. Orosz, None; B. Seitz, None; A.F. Kiderlen, None; M. Bischoff, None; N. Szentmáry, None, (Copyright 2020 The Authors.)

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn's disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients., (© 2020 The Authors. Published by the British Institute of Radiology.)

Objective: Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery., Methods: In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery ( n = 24). Of these patients, 13 (54%) had more than one previous sternotomy., Results: Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months., Conclusions: Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.

We aimed to compare LDH release assay, trypan blue and fluorescent stainings, and non-nutrient Escherichia coli plate assay in determining treatment efficacy of antiamoebic agents against Acanthamoeba castellanii trophozoites/cysts, in vitro. 1BU trophozoites/cysts were challenged with 0.02% polyhexamethylene biguanid (PHMB), 0.1% propamidine isethionate (PD), and 0.0065% miltefosine (MF). Efficacies of the drugs were determined by LDH release and trypan blue assays, by Hoechst 33343, calcein-AM, and ethidium homodimer-1 fluorescent dyes, and by a non-nutrient agar E. coli plate assay. All three antiamoebic agents induced a significant LDH release from trophozoites, compared to controls (p < 0.0001). Fluorescent-dye staining in untreated 1BU trophozoites/cysts was negligible, but using antiamoebic agents, there was 59.3%-100% trypan blue, 100% Hoechst 33342, 0%-75.3% calcein-AM, and 100% ethidium homodimer-1 positivity. On E. coli plates, in controls and MF-treated 1BU trophozoites/cysts, new trophozoites appeared within 24 h, encystment occurred after 5 weeks. In PHMB- and PD-treated 1BU throphozoites/cysts, irregularly shaped, smaller trophozoites appeared after 72 h, which failed to form new cysts within 5 weeks. None of the enzymatic- and dye-based viability assays tested here generated survival rates for trophozoites/cysts that were comparable with those yielded with the non-nutrient agar E. coli plate assay, suggesting that the culture-based assay is the best method to study the treatment efficacy of drugs against Acanthamoeba.

Invasion and persistence of bacteria within host cells requires that they adapt to life in an intracellular environment. This adaptation induces bacterial stress through events such as phagocytosis and enhanced nutrient-restriction. During stress, bacteria synthesize a family of proteins known as heat shock proteins (HSPs) to facilitate adaptation and survival. Previously, we determined the Staphylococcus aureus HSP ClpC temporally alters bacterial metabolism and persistence. This led us to hypothesize that ClpC might alter intracellular survival. Inactivation of clpC in S. aureus strain DSM20231 significantly enhanced long-term intracellular survival in human epithelial (HaCaT) and endothelial (EA.hy926) cell lines, without markedly affecting adhesion or invasion. This phenotype was similar across a genetically diverse collection of S. aureus isolates, and was influenced by the toxin/antitoxin encoding locus mazEF. Importantly, MazEF alters mRNA synthesis and/or stability of S. aureus virulence determinants, indicating ClpC may act through the mRNA modulatory activity of MazEF. Transcriptional analyses of total RNAs isolated from intracellular DSM20231 and isogenic clpC mutant cells identified alterations in transcription of α-toxin (hla), protein A (spa), and RNAIII, consistent with the hypothesis that ClpC negatively affects the intracellular survival of S. aureus in non-professional phagocytic cells, via modulation of MazEF and Agr.

The discipline of perioperative medicine provides a foundation for the consistent delivery of safe and good quality care to surgical patients. Its goals include the identification and optimal care of the high-risk surgical patient, fostering patient-centred decision making throughout the surgical perioperative pathway, and reducing unwarranted variation in practice. In turn, this should reduce preventable complications and improve patient satisfaction, long-term morbidity and survival. This review concludes a series of articles which have described the epidemiology of surgical disease, the growth in the objective means of risk assessment, and novel outcome measures. It describes shortcomings in current practice, and how perioperative care pathways may overcome these. It discusses the growth of enhanced recovery programmes, which exemplify many of the sub-specialty's principles of patient-centred and coordinated care. Reported initiatives to modify local health-care systems, such as the Perioperative Surgical Home, are presented. Consideration is given to how clinicians can use the philosophy and tools of quality improvement methodology, with important current examples. The article concludes by looking at obstacles to change when introducing new frameworks and the future horizons for the discipline.

This case describes the technique of using dual Novalungs (a pumpless extracorporeal system) to bridge a patient with idiopathic pulmonary hypertension to bilateral lung transplantation. A 41-year old lady with idiopathic pulmonary hypertension (with a possible veno-occlusive element) presented with symptoms of end-stage heart and lung failure. This was refractory to medical management with iloprost, sildenafil and bosentan. The patient was placed on the urgent waiting list for lung transplantation and central pulmonary artery to left atrial Novalung insertion was performed. Local anaesthetic was given before performing peripheral cardiopulmonary bypass due to the high risk of cardiac arrest. Two days later, donor organs became available and the patient was taken for double-lung transplantation. The pulmonary artery cannula was removed leaving a large defect. This was then closed using a bovine pericardial patch. Due to the damaged right superior pulmonary vein from Novalung cannulation, cardioplegia was given to facilitate an open atrial anastomosis. After 13 days in the intensive therapy unit, she was transferred to the ward. There were no further complications and she has been discharged home., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Distal radius fractures are common and traditionally these injuries are treated non-operatively. Percutaneous wiring has been recommended as simple method to provide extra stability in distal radius fractures but their exact role is uncertain. The aim of this study was to retrospectively compare the radiographic and functional outcomes following cast immobilisation and those following wire fixation in the management of distal radius fractures and investigate which method produced better outcomes., Methods: A retrospective parallel case series was performed between April 2011 and April 2013 of patients over 50 years treated with either cast immobilisation or wire fixation. Both intra- and extra-articular fractures were included. Radiographic measurements were made pre-operatively and at three months follow up. The QuickDASH was recorded by postal questionnaire at a mean of 2 years., Results: 159 patients were included; 85 cast immobilisation group and 74 wire fixation group. Improvement in radiological parameters was seen in both groups but this was significantly better after wire fixation ([Formula: see text]). QuickDASH scores were available in 64%; no significant difference in mean scores was seen after (p = 0.147); cast immobilisation 27.1 and wire fixation 26.6., Conclusions: Cast immobilisation can produce comparable functional results to wire fixation despite worse radiological outcomes.

A 20-year-old man suffered a closed rupture of both flexor tendons in the middle finger while playing rugby. Primary repair of the flexor digitorum profundus and excision of the flexor digitorum superficialis was performed. At follow up he reported a Disabilities of the Arm, Shoulder and Hand score of 0 and unrestricted return to activities.

Production of "Egusi" melon (Colocynthis citrullus L.) in West Africa is limited by fungal diseases, such as Alternaria leaf spot and Fusarium wilt. In order to engineer "Egusi" resistant to these diseases, cotyledonary explants of two "Egusi" genotypes, 'Ejagham' and NHC1-130, were transformed with Agrobacterium tumefaciens strain EHA101 harbouring wasabi defensin gene (isolated from Wasabia japonica L.) in a binary vector pEKH1. After co-cultivation for 3 days, infected explants were transferred to MS medium containing 100 mg l(-l) kanamycin to select transformed tissues. After 3 weeks of culture, adventitious shoots appeared directly along the edges of the explants. As much as 19 out of 52 (36.5%) and 25 out of 71 (35.2%) of the explants in genotype NHC1-130 and 'Ejagham', respectively, formed shoots after 6 weeks of culture. As much as 74% (14 out of 19) of the shoots regenerated in genotype NHC1-130 and 72% (18 out of 25) of those produced in genotype 'Ejagham' were transgenic. A DNA fragment corresponding to the wasabi defensin gene or the selection marker nptII was amplified by PCR from the genomic DNA of all regenerated plant clones rooted on hormone-free MS medium under the same selection pressure, suggesting their transgenic nature. Southern blot analysis confirmed successful integration of 1-5 copies of the transgene. RT-PCR, northern and western blot analyses revealed that wasabi defensin gene was expressed in transgenic lines. Transgenic lines showed increased levels of resistance to Alternaria solani, which causes Alternaria leaf spot and Fusarium oxysporum, which causes Fusarium wilt, as compared to that of untransformed plants.

Background: There is an increasing trend for managing dorsally angulated distal radial fractures with locked volar plate fixation in fractures that may have previously been managed with percutaneous Kirschner wire (K-wire) fixation. There has been no prospective randomised trial comparing locked volar plate fixation with percutaneous K-wire fixation. In the absence of data guiding management with regard to clinical effectiveness, we have examined the cost of each technique., Methods: Patients' details were collected retrospectively between June 2007 and June 2008. Ten consecutive patients who underwent percutaneous K-wire fixation for a distal radius fracture and the 10 who were treated by locked volar plate fixation were identified and their hospital notes retrieved. All patients had a closed extra-articular distal radial fracture with dorsal angulation. The duration and type of operation, including number of wires or screws used, were recorded., Results: The mean age of the patients was 54 years for the locking plate group and 34 years for the percutaneous K-wire group. The mean time taken to perform percutaneous K-wire fixation with an average of two K-wires was 56 min. The mean time for applying a volar locked plate was 121 min. The cost of a pack of 10 K-wires was 3 pounds. The total cost of a standard volar locking plate and screws used was 787 pounds., Discussion: In the absence of research comparing clinical end points, cost must play a major factor in determining the type of operation offered. A 56-min operation to percutaneously fix a distal radial fracture with K-wires costs 662 pounds. This compares to a cost of 2212 pounds for a 121-min locked volar plate fixation. There is a calculated difference of 1549 pounds and 65 min., Conclusion: With use of a locked volar plate for patients under the age of 70 years there is a loss of 652 pounds for the Trust with the present NHS tariffs.

In this article, we review the role played by myectomy in cardiac surgery. For this purpose, we looked at three cases of different etiology where myectomy in conjunction with treatment of the primary condition proved invaluable in the outcome of these patients. The primary conditions requiring treatment were subaortic membrane, hypertrophic obstructive cardiomyopathy with mitral valve regurgitation, and aortic stenosis.

There is a growing literature regarding the use of recombinant activated factor VII (rFVIIa) (NovoSeven, NovoNordisk, Copenhagen, Denmark) to control refractory hemorrhage after cardiopulmonary bypass in cardiac surgery. This supporting evidence is mostly documented as case reports on patients, of which only six involve coronary artery grafting. We present our experience of a patient undergoing coronary artery bypass grafting, who suffered an anaphylactic reaction to protamine preventing safe reversal of systemic heparinization. Subsequent management of postoperative bleeding was successfully achieved only after rFVIIa administration.

Objective: Off-pump CABG is potentially associated with reduced intraoperative blood loss and homologous blood transfusion in comparison to on-pump CABG. In this randomised controlled study we investigated the effects of autologous cell saver blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing CABG on- versus off-CPB., Methods: Eighty patients were randomised into one of four groups: (A) on-CPB with cell saver blood transfusion (CSBT), (B) on-CPB without CSBT, (C) off-pump with CSBT and (D) off-pump without CSBT. Volume of intraoperative autologous blood transfusion, postoperative mediastinal blood loss and homologous blood transfusion requirements were measured. Homologous blood was transfused when haemoglobin concentration fell below 8 g/dl postoperatively. Pre- and postoperatively prothrombin time and partial thromboplastin time were measured., Results: Preoperative patient characteristics were well matched among the four groups. The amount of salvaged mediastinal blood available for autologous transfusion was significantly higher in the on-pump group (A) compared to the off-CPB group (C) (433+/-155 ml vs 271+/-144 ml, P=0.001). Volume of homologous blood transfusion was significantly higher in group B vs groups A, C and D (595+/-438 ml vs 179+/-214, 141+/-183 and 230+/-240 ml, respectively, P<0.005). The cell saver groups (A and C) received significantly less homologous blood than the groups without cell saver (160+/-197 ml vs 413+/-394 ml, respectively, P<0.005). Patients undergoing off-CPB surgery received significantly less homologous blood than those undergoing on-CPB CABG irrespective of cell saver blood transfusion (184+/-214 ml vs 382+/-397 ml, P<0.05). Postoperative blood loss was similar in the four groups (842+/-276, 1023+/-291, 869+/-286 and 903+/-315 ml in groups A to D, respectively, P>0.05). Clotting test results revealed no significant difference between the groups. There was no significant difference in postoperative morbidity between groups., Conclusion: Off-pump CABG is associated with significant reduction in intraoperative mediastinal blood loss and homologous transfusion requirements. Autologous transfusion of salvaged washed mediastinal blood reduced homologous transfusion significantly in the on-CPB group. Cell saver caused no significant adverse impact on coagulation parameters in on- or off-CPB CABG. Postoperative morbidity and blood loss were not affected by the use of CPB or autologous blood transfusion. We recommend the use of autologous blood transfusion in both on- and off-pump CABG surgery.

Objectives: Off-pump coronary revascularisation is demanding technically as the surgeon is faced with a beating heart and not a bloodless field. The potential clinical advantages of off-pump coronary revascularisation have made this procedure an essential part of a cardiothoracic training program. The aim of this study is to investigate the impact of teaching trainees complex off-pump coronary artery surgery (arterial grafting, 'Y' grafts, sequential grafting and minimally invasive direct coronary artery bypass) on clinical outcomes., Methods: All 323 off-pump coronary revascularisation cases performed by one service over a 24-month period were analysed. The 125 (39%) operations performed by two trainees with previous exposure in on-pump surgery were compared with the 198 (61%) performed by an experienced consultant surgeon. Patient and disease characteristics, intra- and post-operative data, morbidity and mortality were analysed using uni- and multivariate analysis., Results: The trainees performed 51% of the MIDCABs, 36% of the 'Y' grafts and 27.5% of the sequential grafts. The internal thoracic artery was used in 96% of the cases, radial artery in 49% and bilateral internal thoracic arteries in 11% equally distributed between trainees and consultant. The average number of grafts per case was 3.7 for the consultant and 3.3 for the trainees. Patients operated by the consultants were more likely to have unstable angina (P=0.008), ejection fraction <30% (P=0.01) previous cardiac surgery (P=0.027) and more likely to receive over 4 grafts (P=0.01). Operative mortality was 1.5% for the consultant and 0 for the trainees (P=0.17). Post-operative morbidity, such as re-operation for bleeding (consultant 1% vs. trainee 0.8%), stroke (0.5% vs. 0.8%), haemofiltration (3.5% vs. 0.8%) was similar between the two groups. Hospital stay was also similar., Conclusions: The results of this study suggest that trainees under supervision perform complex off-pump coronary artery surgery safely with low rate of mortality and complications. These findings are in agreement with previous literature reports. Trainees should be allowed to operate on sufficient number of patients undergoing off-pump surgery according to their skills and abilities. Patients should be reassured that safety is not compromised by the presence of a trainee as a primary surgeon.

Background: The technique of off-pump coronary artery bypass graft (OPCABG) surgery differs considerably from on-pump CABG. This study investigates the impact of surgical training on clinical outcome in patients undergoing OPCABG., Methods: All 251 OPCABG cases performed by one service over an 18-month period were analyzed. The 83 operations (33%) performed by two trainees under supervision were compared with the 168 operations (67%) performed by an experienced consultant surgeon. Patient and disease characteristics, intraoperative and postoperative data, morbidity and mortality were analyzed using univariate and multivariate analysis. Data were extracted from a prospective database., Results: Patients operated on by the consultant were more likely to have had unstable angina (p = 0.003, odds ratio [OR] = 3.5), impaired left ventricular function (ejection fraction < 0.3; p = 0.005, OR = 2.4), or previous cardiac surgery (p = 0.03). They were more likely to receive three or more grafts (p = 0.017, OR = 2.0). Operative mortality was 2.4% (consultant) and 0% (trainees; p = 0.31). Postoperative morbidity, such as reoperation for bleeding (consultant 3% versus trainees 1.2%), stroke (0.6% versus 1.2%), and hemofiltration (3.6% versus 0%) was similar between the two patient groups. Stay in the intensive care unit was not significantly different in the two groups., Conclusions: In our experience, trainee surgeons are less likely to operate on patients with unstable angina or cardiac dysfunction. Operative morbidity and mortality are, however, similar in patients operated on by either an experienced consultant surgeon or trainees. We believe OPCABG can be taught safely to trainees under supervision.

Background: : Coronary revascularization is associated with respiratory dysfunction and poor gas exchange postoperatively. Cardiopulmonary bypass (CPB) has been implicated as a possible explanation for this phenomenon. This study investigated respiratory function in patients undergoing coronary artery bypass grafting (CABG) on-CPB versus off-CPB to determine whether the off-CPB condition results in improved postoperative pulmonary function., Methods: : Forty patients were randomized into 1 of 2 groups: CABG on-CPB (group A) or off-CPB (group B). Pulmonary function tests, including spirometry and diffusion studies, were performed preoperatively and on postoperative day 5. Arterial blood gases on 100% oxygen were taken preoperatively (TP1), 15 minutes after sternal closure (TP2), and 3 hours postoperatively (TP3)., Results: : The arterial partial pressure of oxygen (PaO2) on FiO2 1.0 decreased from 59.5 ± 11.5 kPa and 55.7 ± 12.2 kPa at TP1 to 39.5 ± 16 kPa and 39.7 ± 13 kPa at TP2 in groups A and B, respectively (P < 0.001), with no significant difference between groups. At TP3, the PaO2 partially recovered toward preoperative levels (P > 0.05).Spirometry revealed a significant reduction in FEV1 and FVC on the fifth postoperative day (P < 0.001), with no significant difference between groups. The corrected transfer factor for carbon monoxide reduced significantly in group A from 7.9 ± 2.5 mmol·min · kPa preoperatively to 5.1 ± 1.6 mmol·min · kPa postoperatively (P < 0.05). This reduction was not seen in group B., Conclusions: : Coronary artery surgery is associated with a marked reduction in lung function as measured by pulmonary function tests and PaO2. Diffusion studies revealed that on-CPB patients had significantly reduced diffusion capacities postoperatively compared with patients in the off-CPB group.