Sutured coronary artery grafting utilizing the Heartflo anastomosis device--first clinical experiences

BACKGROUND: The Heartflo device was developed to facilitate consistency in distal coronary anastomosis quality. The device automates the suturing process during the anastomosis procedure via simultaneous delivery of ten standard 7-0 polypropylene sutures through the graft and the coronary vessel wall. METHODS: In 30 elective coronary artery bypass patients, one distal anastomosis was intentionally performed with the anastomosis device. Device success was stated if a patent anastomosis with a minimal flow of 50 ml/min resulted, additional stitches were counted if bleeding occurred. RESULTS: 4 cases of device failure occurred in the first 5 patients. The subsequent patients were operated without any mechanical problems. In 16 patients (53 %), a patent anastomosis with a mean flow of 75 +/- 6 ml/min using 1.7 +/- 0.3 additional stitches was achieved. Anastomoses were completed in 19.0 +/- 0.7 min; postoperative course was uneventful in all patients. CONCLUSIONS: We have shown that coronary anastomoses are feasible using the Heartflo device, representing a promising step on the way to automated coronary anastomoses. Its application is still limited by the size and tissue quality of the target vessel and difficult suture management during the anastomosis procedure.     

Towards realistic estimates of HCV incidence in Egypt

Accurate incidence estimates are essential for quantifying hepatitis C virus (HCV) epidemic dynamics and monitoring the effectiveness of public health programmes, as well as for predicting future burden of disease and planning patient care. In Egypt, the country with the largest HCV epidemic worldwide, two modelling studies have estimated age‐specific incidence rates that, applied to the age pyramid, would correspond to more than 500 000 Egyptians getting infected annually. This is in contrast to figures of the Egyptian Ministry of Health and Population that estimates new infections to be approximately 100 000 per year. We performed new analyses of nationwide data to examine the modelling assumptions that led to these estimates. Thus, we found that the key assumption of these models of a stationary epidemic is invalid. We propose an alternate approach to estimating incidence based on analysing cohort data; we find that the number of annual new infections is <150 000.     

Fibroscan of chronic HCV patients coinfected with schistosomiasis

Background and study aimsBoth hepatitis C virus (HCV) and schistosomiasis are highly endemic in Egypt and coinfection is frequently encountered. Such coinfection is responsible for leading to a more severe liver disease. Hence, the aim of the study was to assess the fibroscan in chronic HCV patients coinfected with Schistosoma.Patients and methodsThis study included 231 chronic HCV patients. Routine pre-treatment work-up was done including anti-schistosomal antibodies. Liver stiffness measurements using fibroscan and reference needle-liver biopsy were done. Patients were categorised into two groups: HCV patients with positive schistosomal serology and HCV patients with negative schistosomal serology.ResultsAnti-schistosomal antibody was positive in 29% of the studied population. Positive schistosomal serology status was significantly associated with the disagreement between the results of liver biopsy (Metavir) and the fibroscan results (p value = 0.02), which was more obvious in F2 and F3 fibrosis stages. The sensitivity of fibroscan for the detection of the F2 stage decreased from 64% among negative schistosomal serology patients to 30.8% among positive schistosomal serology patients, and for the F3 stage it decreased from 43.8% to 21.4%, respectively. Multivariate logistic regression showed that fibrosis stages (F0–F1 and F4) were the most independent factors that were associated with the agreement between fibroscan and liver biopsy (odds ratio (OR) 3.4, 7.12 and p value <0.001, <0.001, respectively).ConclusionAlthough the sensitivity of fibroscan for the detection of fibrosis stages (F2 and F3) was impaired in patients with positive schistosomal serology, fibrosis stages (F0–F1 and F4) were the most independent factors associated with the agreement between fibroscan and liver biopsy.     

Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus

Objective

The aim of this study was the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensively calcified mitral annulus who underwent decalcification and patch reconstruction.

Patients and Methods

Between 1996 and 2008 a total of 109?patients underwent surgery for extensive calcification and severe mitral insufficiency and mitral stenosis. The mean age of the patients (65?women and 44?men) was 66.4±13.8?years. In 53?patients (49%) mitral valve repair was performed and the remaining 56?patients (51%) received a mitral valve replacement. Of the patients 64 (59%) required concomitant surgery. The mean follow up time was 96±48?months.

Results

The in-hospital and late mortality was 8.3% (9?patients) and 25.6% (28?patients), respectively. The actuarial survival rates at 5, 8 and 12?years were 88.1%, 76.2% and 66.1%, respectively. Echocardiographic follow-up presented a mitral insufficiency grade III in 4?patients (6%). None of the patients had a mitral insufficiency grade IV. A significant reduction of left atrium diameter, of the LVEDD as well as the mean transvalvular gradient was observed. Freedom from reoperation at 5 and 8?years was 96.4% and 91.8%, respectively. Systemic hypertension, diabetes mellitus, age older than 65?years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history were found to be predictors for significantly increased early or late mortality.

Conclusion

The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high risk patients.     

Echokardiographische und klinische Evaluation nach Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus im Langzeitverlauf

Objective

The aim of this study is the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensive calcified mitral annulus who underwent decalcification and patch reconstruction.

Patients and Methods

Between 1996 and 2008 a total of 109?patients underwent surgery in the presence of extensive calcification, severe mitral insufficiency and mitral stenosis. The mean age of patients (65?women, 44?men) was 66.4±13.8?years. Mitral valve repair was performed in 53?patients (49%), while the remaining 56?patients (51%) received a mitral valve replacement. In all, 64?patients (59%) required concomitant surgery. The mean follow-up time was 96±48?months.

Results

Inpatient and late mortality rates were 8.3% (nine patients) and 25.6% (28?patients), respectively. The actuarial survival rates at 5, 8 and 12?years were 88.1%, 76.2% and 66.1%. Echocardiographic follow-up demonstrated mitral insufficiency?III in four patients (6%). No patients had mitral insufficiency?IV. We observed a significant reduction in left atrium diameter, LVEDD as well as mean transvalvular gradient. Freedom from reoperation at 5 and 8?years was 96.4% and 91.8%, respectively. We found systemic hypertension, diabetes mellitus, age above 65?years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history as predictors for significantly increased early or late mortality.

Conclusion

The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high-risk patients.     

Simeprevir plus sofosbuvir for eight or 12 weeks in treatment‐naïve and treatment‐experienced hepatitis C virus genotype 4 patients with or without cirrhosis

The OSIRIS study investigated efficacy and safety of simeprevir plus sofosbuvir for eight or 12 weeks in hepatitis C virus (HCV) genotype 4‐infected patients with METAVIR F0‐F4 fibrosis. Sixty‐three patients (33 treatment‐naïve and 30 peg‐interferon/ribavirin (Peg‐IFN/RBV)‐experienced) enrolled in a partly randomized, open‐label, multicentre, phase IIa study. Patients with F0‐F3 fibrosis were randomized (1:1) into two groups (A1 and A2), stratified according to treatment experience and METAVIR score, to receive either eight weeks (Group A1, n=20) or 12 weeks (Group A2, n=20) of treatment. Patients with compensated cirrhosis (METAVIR F4) received 12 weeks of treatment (Group B, n=23). Treatment comprised simeprevir 150 mg and sofosbuvir 400 mg daily. The primary efficacy endpoint was sustained virologic response 12 weeks after planned end of treatment (SVR12). Safety and tolerability were assessed throughout. Overall, 92% (95% CI: 82‐97) of patients achieved SVR12; 75% (15/20) in Group A1 and 100% in groups A2 and B. Patients who did not achieve SVR12 (n=5) experienced viral relapse during the first 32 days following treatment and were all prior Peg‐IFN/RBV null responders. The most commonly reported treatment‐emergent adverse events (TEAEs) were asymptomatic lipase increase (14%), pruritus (14%), headache (13%) and hyperbilirubinaemia (11%). No patients discontinued due to TEAEs. In conclusion, simeprevir plus sofosbuvir for 12 weeks achieved a 100% SVR rate in HCV genotype 4‐infected patients with or without compensated cirrhosis (ClinicalTrials.gov: NCT02278419). The AE and laboratory profile were favourable and consistent with previous data for simeprevir plus sofosbuvir in eight‐ and 12‐week regimens.     

Highly heterogeneous nature of delta-aminolevulinate dehydratase (ALAD) deficiencies in ALAD porphyria

The properties of 9 delta-aminolevulinate dehydratase (ALAD) mutants from patients with ALAD porphyria (ADP) were examined by bacterial expression of their complementary DNAs and by enzymologic and immunologic assays. ALADs were expressed as glutathione-S-transferase (GST) fusion proteins in Escherichia coli and purified by glutathione-affinity column chromatography. The GST-ALAD fusion proteins were recognized by anti-ALAD antibodies and were enzymatically active as ALAD. The enzymatic activities of 3 ALAD mutants, K59N, A274T, and V153M, were 69.9%, 19.3%, and 41.0% of that of the wild-type ALAD, respectively, whereas 6 mutants, G133R, K59N/G133R, F12L, R240W, V275M, and delTC, showed little activity (< 8%). These variations generally reflect the phenotype of ALAD in vivo in patients with ADP and indicate that GST-ALAD fusion protein is indeed useful for predicting of the phenotype of ALAD mutants. The location of F12L mutation in the enzyme's molecular structure indicates that its disturbance of the quaternary contact of the ALAD dimer appears to have a significant influence on the enzymatic activity. Mouse monoclonal antibodies to human ALAD were developed that specifically recognized a carboxy terminal portion of ALAD, or other regions in the enzyme. This study represents the first complete analysis of 9 mutants of ALAD identified in ADP and indicates the highly heterogeneous nature of mutations in this disorder.     

Two-dimensional modulation transfer functions for rotational panoramic radiography

The two-dimensional modulation transfer function (MTF) provides a method for describing resolution in panoramic x-ray systems where the process of image formation differs in the horizontal and vertical dimensions. As an example, two-dimensional MTFs for the Philips OrthOralix SD machine were calculated from point spread functions (PSF) describing the various sources of unsharpness within the system. The PSF for the focal spot was measured using a pinhole camera. The PSF for the screen-film combination was calculated from data supplied by the manufacturer. The PSF for the motion blurring that is inherent in rotational panoramic radiography was derived from standard mathematical models. The three functions were convolved together to obtain the PSF of the entire system and the two-dimensional MTF was derived from the system PSF by Fourier transformation. The two-dimensional MTF provides a tool which should be useful in the future for the evaluation of existing systems, for the design of improved equipment, and for the implementation of image processing algorithms.     

Point spread functions for rotational panoramic radiography: An experimental test

Point spread functions for rotational panoramic radiography were determined experimentally. The results were compared with theoretically functions calculated from known system parameters. There was a satisfactory agreement between theoretically and experimentally obtained data. It is concluded that theoretically calculated point spread functions and their blurring effects in panoramic radiography give reliable results.