Wound ventilation with ultraclean air for prevention of direct airborne contamination during surgery.

BACKGROUND AND OBJECTIVE: Despite the novelties in operating room ventilation, airborne bacteria remain an important source of surgical wound contamination. An ultraclean airflow from the ceiling downward may convey airborne particles from the surgical team into the wound, thus increasing the risk of infection. Therefore, similar ventilation from the wound upward should be considered. We investigated the effect of wound ventilation on the concentration of airborne particles in a wound model during simulated surgery. DESIGN: Randomized experimental study simulating surgery with a wound cavity model. SETTING: An operating room of a university hospital ventilated with ultraclean air directed downward. INTERVENTIONS: Particles 5 microm and larger were counted with and without a 5-cm deep cavity and with and without the insufflation of ultraclean air. RESULTS: With the surgeon standing upright, no airborne particles could be detected in the wound model. In contrast, during simulated operations, the median number of particles per 0.1 cu ft reached 18 (25th and 75th percentiles, 12 and 22.25) in the model with a cavity and 15.5 (25th and 75th percentiles, 14 and 21.5) without. With a cavity, wound ventilation markedly reduced the median number of particles to 1 (range, 0 to 1.25; P < .001). CONCLUSIONS: To protect a surgical wound against direct airborne contamination, air should be directed away from the wound rather than toward it. This study provides supportive evidence to earlier studies that operating room ventilation with ultraclean air is imperfect during surgical activity and that wound ventilation may be a simple complement. Further clinical trials are needed.     

The Effect of Reading Interventions among Poor Readers at a Forensic Psychiatric Clinic

The aim of the present study was to investigate the effect of a short period, 15 sessions, of reading interventions in a sample of adult forensic psychiatric patients: 61 patients with decoding difficulties – 44 in the experimental group and 17 in the comparison group – with an average age of 31.6 participated. Of these, 36% were female, and 29% had an immigrant background. The participants carried out a battery of reading tests. The results in the experimental group showed a medium effect size (d = .36 to .76) on all reading tests between pre- and post-test. The comparison group, however, showed no gain at all between the test occasions. The results indicate that a proportionally low reading intervention effort produces improvement in reading. This study discusses the importance of including reading assessment and offering remediation in order to reach optimal future social adjustment for patients in forensic clinics.     

MYC inhibition induces metabolic changes leading to accumulation of lipid droplets in tumor cells

The MYC genes are the most frequently activated oncogenes in human tumors and are hence attractive therapeutic targets. MYCN amplification leads to poor clinical outcome in childhood neuroblastoma, yet strategies to modulate the function of MYCN do not exist. Here we show that 10058-F4, a characterized c-MYC/Max inhibitor, also targets the MYCN/Max interaction, leading to cell cycle arrest, apoptosis, and neuronal differentiation in MYCN-amplified neuroblastoma cells and to increased survival of MYCN transgenic mice. We also report the discovery that inhibition of MYC is accompanied by accumulation of intracellular lipid droplets in tumor cells as a direct consequence of mitochondrial dysfunction. This study expands on the current knowledge of how MYC proteins control the metabolic reprogramming of cancer cells, especially highlighting lipid metabolism and the respiratory chain as important pathways involved in neuroblastoma pathogenesis. Together our data support direct MYC inhibition as a promising strategy for the treatment of MYC-driven tumors.     

The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model

Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the “value for money.” The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to “status quo” (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.     

Aortic Valve Replacement Using Local Myocardial Hypothermia

This material comprises 100 cases of aortic valve replacement. Ninety-one of the valves were replaced with the Björk—Shiley tilting disc valve prosthesis and 9 with the Smeloff—Cutter ball valve. No coronary perfusion was used during surgery. The myocardium was protected by local myocardial hypothermia, achieved by an intracoronary infusion of Bretschneider's solution (+4°C) prior to surgery. A weak and flaccid heart without coronary perfusion cannulas facilitated the surgical procedure. Myocardial function was very good and the course of the patients excellent postoperatively. Seven percent of the patients were lost within one month after operation and late mortality was 13%. A comparison between clinical and haemodynamic findings obtained 2–3 months before and one year after surgery was made in 55 patients. A marked subjective improvement was seen in all but five patients. There was a significant increase of average physical working capacity and regression of ECG-signs of left ventricular hypertrophy and strain as well as of roentgenological heart size. Angina pectoris was present in only three patients postoperatively as compared with 23 before surgery. The improvement of physical working capacity was paralleled by a significant increase of cardiac output during exercise, caused by a rise of stroke volume, heart rate on maximal load tolerated remaining unchanged. Blood pressure reactions during work were normalized in patients with both pre-operative aortic stenosis and aortic insufficiency. A significant postoperative paravalvular leakage was rare in the present material.