Redo mitral valve surgery using the port-access system

Redo mitral valve surgery is hazardous, hence we explored an alternative approach using a port-access system that avoids reentry. Between October 1997 and December 2000, 32 patients underwent mitral reoperation using the system. All patients had previous cardiac operations. This procedure consisted of a right anterolateral minithoracotomy and femorofemoral cannulation using special port-access instruments and endoaortic clamping in 24 patients or direct transthoracic sliding-rod aortic clamping in 8. The valve disease was of rheumatic etiology in 28 patients and degenerative in 4. The valve was replaced in 31 cases and a paravalvular leak after mitral valve replacement was closed in 1. In 2 cases, the tricuspid valve was repaired along with mitral valve replacement. Mean total operating time was 4.5 +/- 1.2 hours, cardiopulmonary bypass time 162 +/- 72 minutes, and aortic crossclamp time 62 +/- 21 minutes. There was no mortality, and mean stay in the intensive care unit was 22 +/- 7 hours and hospital stay 6.4 +/- 1.2 days. Postoperative blood transfusion was required in 12 patients. In view of the favorable results, we recommend using the port-access system as a standard approach for mitral reoperation.     

Establishment of a Maternal Newborn Health Registry in the Belgaum District of Karnataka,India

Background

Pregnancy-related vital registration is important to inform policy to reduce maternal, fetal and newborn mortality, yet few systems for capturing accurate data are available in low-middle income countries where the majority of the mortality occurs. Furthermore, methods to effectively implement high-quality registration systems have not been described. The goal of creating the registry described in this paper was to inform public health policy makers about pregnancy outcomes in our district so that appropriate interventions to improve these outcomes could be undertaken and to position the district to be a leader in pregnancy-related public health research.

Methods

We created a prospective maternal and newborn health registry in Belgaum, Karnataka State, India. To initiate this registry, we worked with the Ministry of Health to first establish estimated birth rates and define the catchment areas of the clusters, working within the existing health system and primary health centers. We also undertook household surveys to identify women likely to become pregnant. We then implemented monitoring measures to ensure high quality and completeness of the maternal newborn health registry. All pregnant women in the catchment area were identified, consented and enrolled during pregnancy, with follow-up visits to ascertain pregnancy outcomes and mother/infant status at 42-days postpartum.

Results

From 2008 through 2014, we demonstrated continued improvements in both the coverage for enrollment and accuracy of reporting pregnancy outcomes within the defined catchment area in Belgaum, India. Nearly 100% of women enrolled had follow-up at birth and 99% had 42-day follow-up. Furthermore, we facilitated earlier enrollment of women during pregnancy while achieving more timely follow-up and decreased time of reporting from the date of the pregnancy event.

Conclusions

We created a pregnancy-related registry which includes demographic data, risk factors, and outcomes allowing for high rates of ascertainment and follow-up while working within the existing health system. Understanding the elements of the system used to create the registry is important to improve the quality of the results. Tracking of pregnancies and their outcomes is an important step toward reducing maternal and perinatal mortality.

     

A dual-functional luminescent Tb(iii) metal–organic framework for the selective sensing of acetone and TNP in water

Herein, a novel water-stable luminescent terbium metal–organic framework, {[Tb(L₁)(L₂)_0.5(NO₃)(DMF)]·DMF}_n (TPA-MOF), with 1,10-phenanthroline (phen) and 3,3′,5,5′-azobenzene-tetracarboxylic acid (H₄abtc) ligands was solvothermally synthesized and structurally characterized. TPA-MOF possesses a two-dimensional (2D) extended framework featuring an 8-connected uninodal SP2-periodic net topology with the Schläfli point symbol of {3^12;4^14;5^2}. The π-electron rich luminescent TPA-MOF exhibits four characteristic emission bands of Tb³⁺ ion and acts as a selective and sensitive probe for acetone as well as the electron deficient 2,4,6-trinitrophenol (TNP). Moreover, gas sorption studies confirm that TPA-MOF displays ultra-micropores and adsorbs moderate amounts of N₂ and CO₂.

A novel 2D luminescent terbium metal–organic framework demonstrating highly efficient and selective sensing for acetone and 2,4,6-trinitrophenol (TNP) in an aqueous solution was solvothermally synthesized and structurally characterized.     

Successful closure of iatrogenic femoral artery pseudoaneurysm: a new minimally invasive technique

Pseudoaneurysm following diagnostic or interventional procedures is a well-known complication. We describe a new method of closing a femoral pseudoaneurysm in a case where ultrasound-guided compression had failed. Instead of packing the sac permanently with coils, thrombus formation was successfully induced by temporary placement of a coil transcutaneously in the psendoaneurysm sac, which resulted in closure of the pseudoaneurysm.     

Relationship between lung function and physical performance in disabled older women

BACKGROUND: Understanding the association between lung function and physical performance in disabled older women helps in determining the potential for prevention and treatment strategies to decrease disability. The aim of this study was to determine the association of lung function with objective and self-reported physical performance in community-dwelling disabled older women. METHODS: The Women's Health and Aging Study I consists of 1002 disabled community-dwelling women aged > or = 65. Of these women, 840 underwent spirometry with determination of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cross-sectional analyses included multivariate linear regression to assess the association between FEV1, FVC, FEV1/FVC, and the time to walk four meters after adjusting for confounders, including age, race, geriatric depression scale score, body mass index, muscle strength, osteoarthritis, smoking status, and cardiovascular disease. Multiple logistic regression was used to assess the association between FEV1, FVC, FEV1/FVC, and self-reported disability in physical performance. RESULTS: FEV1 was independently associated with time to walk 4 meters. For every 100 ml decrease in FEV1, there was a 0.15-second (95% confidence interval: 0.24 to 0.06) increase in time to walk 4 meters. There was an 8% increase in the prevalent odds of self-reported disability in physical performance for every 100 ml decrease in FEV1. FVC was also associated with physical performance measures. In contrast, FEV1/FVC was associated with objective but not subjective physical performance. CONCLUSION: Decreasing lung function is independently associated with decrements in objective and self-reported physical performance in disabled older women.     

Nodal Langerhans cell histiocytosis with prominent eosinophilic emperipolesis

Multinucleated giant cells of osteoclastic type are known to occur in nodal and extranodal lesions of Langerhans cell histiocytosis (LCH). These giant cells are thought to be derived from phagocytic histiocytes, which correlate with the degree of necrosis in LCH lesions. Emperipolesis commonly seen in Rosai–Dorfman disease is a distinct phenomenon characterized by intact phagocytosed cells in an intracytoplasmic vacuole protected from proteolytic digestion. We present a case of emperipolesis of inflammatory cells especially of eosinophils by multinucleated giant cells of Langhans type in a lymph node involved by LCH—a finding that has not been described previously in the literature. Diagn. Cytopathol. 2015;43:1000–1002. © 2015 Wiley Periodicals, Inc.