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Purpose The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery. Methods A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed 'poor outcome', which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation. Results After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51-18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10-2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28-2.74, p = 0.001). Conclusions The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults., Author(s): Yumiko Yamazaki [sup.1] , Koji Oba [sup.2] , Yoshiro Matsui [sup.3] , Yuji Morimoto [sup.1] Author Affiliations: (Aff1) 0000 0001 2173 7691, grid.39158.36, Anesthesiology and Critical Care Medicine, Hokkaido [...]

The ability to think logically is a hallmark of human intelligence, yet our innate inferential abilities are marked by implicit biases that often lead to illogical inference. For example, given AB ("if A then B"), people frequently but fallaciously infer the inverse, BA. This mode of inference, called symmetry, is logically invalid because, although it "may" be true, it is not "necessarily" true. Given pairs of conditional relations, such as AB and BC, humans reflexively perform two additional modes of inference: transitivity, whereby one (validly) infers AC; and equivalence, whereby one (invalidly) infers CA. In sharp contrast, nonhuman animals can handle transitivity but can rarely be made to acquire symmetry or equivalence. In the present study, human subjects performed logical and illogical inferences about the relations between abstract, visually presented figures while their brain activation was monitored with fMRI. The prefrontal, medial frontal, and intraparietal cortices were activated during all modes of inference. Additional activation in the precuneus and posterior parietal cortex was observed during transitivity and equivalence, which may reflect the need to retrieve the intermediate stimulus (B) from memory. Surprisingly, the patterns of brain activation in illogical and logical inference were very similar. We conclude that the observed inference-related fronto-parietal network is adapted for processing categorical, but not logical, structures of association among stimuli. Humans might prefer categorization over the memorization of logical structures in order to minimize the cognitive working memory load when processing large volumes of information.

Abstract Background An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. Methods SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. Results Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. Conclusion SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.