20 years of arterial switch operation for simple TGA

Background : Arterial switch operation became the golden treatment for simple transposition of the great arteries (sTGA). We describe our experience with the arterial switch operation regarding long-term outcome and the need for re-intervention. Nevertheless, supravalvular pulmonary stenosis (SPS) remains a concern in the long run. We assess the evolution of SPS over time and evaluate the effect of technical modifications on SPS during our experience. Methods : We performed a retrospective study on 133 patients operated with ASO for TGA between October 1991 and November 2009. Last report method was used. We reviewed our pediatric cardiology and cardiac surgery database to examine the echocardiography data and electrocardiograms. A mean follow-up of 9.2 years (± 5.83 SD) was reached. Results : One (0.8%) patient deceased postoperatively due to cardiogenic shock. The overall actuarial freedom from reoperation (open and percutaneous) was 88.1%, 78.5% and 76.9% at 1, 5 and 10 years. SPS needed to be treated in 17 patients. Valve regurgitation at final investigation was maximal moderate in 5 patients for the aortic valve, 10 for pulmonary valve and 3 in tricuspid valve.

Conclusions : ASO shows excellent long-term results in sTGA with a very low morbidity and mortality and is therefore the procedure of choice. Re-intervention rate is determined by SPS. Since the extensive mobilization of the pulmonary arteries and the creation of a longer neo-pulmonary root, reduction in SPS was seen with no re-interventions in the second half of the group. To obtain a final comparison with the atrial switch operation, a longer Follow-up is necessary.     

Cervical fracture patterns associated with blunt cerebrovascular injures when utilizing computed tomographic angiography: a systematic review and meta-analysis

BACKGROUND CONTEXTPrior studies have demonstrated an association between cervical spine fractures and blunt cerebrovascular injuries (BCVI) due to the intimate anatomic relationship between the cervical spine and the vertebral arteries. Digital subtraction angiography (DSA) has historically been the gold standard, but computed tomography angiography (CTA) is commonly used to screen for BCVI in the trauma setting. However, there is no consensus regarding which fracture patterns mandate screening. Over aggressive screening may lead to increased radiation, increased false positives, and overtreatment of patients which can cause unnecessary patient harm, and increased healthcare costs.PURPOSEThe aim of this meta-analysis is to analyze which cervical spine fracture patterns are most predictive of BCVI when utilizing CTA.STUDY DESIGN/SETTINGSystematic review and meta-analysis.OUTCOME MEASURESOdds ratios for specific cervical fracture patterns and risk of developing a BCVI.METHODSA systematic literature review of all English language studies from 2000-2020 was conducted. The year 2000 was chosen as the cut-off because use of CTA prior to 2000 was rare. Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, Global Index Medicus, and ClinicalTrials.gov were queried. Studies were included if they met the following criteria: (1) the diagnostic imaging modality was CTA; (2) investigated blunt cervical trauma; (3) noted specific cervical spine fracture patterns associated with BCVI; (4) odds ratios for specific cervical spine fracture patterns or the odds ratio could be calculated; (5) subjects were 18 years old or older. Studies were excluded if they: (1) included DSA or magnetic resonance imaging; (2) included penetrating cervical trauma; (3) included pediatric patients less than 18 years of age; (4) were not written in English. All statistical analysis was performed using R Studio (RStudio, Boston, MA, USA).RESULTSThe initial search, after duplicates were removed, resulted in 10,940 articles for independent review. Six studies met the criteria for inclusion in the meta-analysis. Specific fracture patterns mentioned are isolated C1, C2, C3 fractures, any C1–C3 fracture, any C4–C7 fracture, two-level fractures, subluxation/dislocations, and transverse foramen (TF) fractures. Three studies were included in the meta-analysis for C1, C2, C1–C3, subluxations/dislocations, and TF fractures. Two studies were included in the meta-analysis for C3, C4–C7, and two-level fractures. The pooled odds ratio with 95% confidence interval for: C1 fractures and BCVI is 1.3 (0.8–2.1); C2: 1.6 (0.9–2.8); C3: 1.8 (0.9–3.6); C1–C3: 2.2 (1.1–4.2); C4–C7: 0.7 (0.3–1.7); Two-level: 2.5 (1.4–4.6); Subluxation/Dislocation: 2.9 (1.8–4.5); TF: 3.6 (1.4–8.9).DISCUSSION/CONCLUSIONThis study found that when utilizing CTA for screening of BCVI only fractures in the C1-C3 region, two-level fractures, subluxations/dislocations, and transverse foramen fractures were associated with increased incidence of a BCVI. Further refinement of protocols for CTA in the setting of blunt cervical trauma may help limit unnecessary patient harm from overtreatment and reduce healthcare costs.     

Microscopia confocal ex vivo con método de fusión y tinción digital: cambiando paradigmas en el diagnóstico histológico

The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces images more quickly and with a higher resolution than before. By means of a fusion mode that combines simultaneously scanned fluorescence and reflectance images, it produces digitally stained images that simulate the effect of hematoxylin-eosin staining. Application of this new technology has opened the door to real-time tissue diagnostics.     

Redefining shared decision-making in the digital era

Perioperative shared decision-making can be improved through the development of novel patient-centered outcome measures made possible by digital phenotyping—“the moment-by-moment quantification of individual-level human phenotype in situ using data from personal digital devices, in particular smartphones.” This Short Report presents data from a patient with breast cancer that illustrates the opportunities of digital phenotyping to better inform patient quality of life while also discussing the challenges to its adoption. With time, effort, and physician engagement, digital phenotyping can help surgeons better understand the patient experience in the postoperative period and in turn, help them provide care that maximizes patient quality of life.     

Influence of implant scanbody material,position and operator on the accuracy of digital impression for complete-arch: A randomized in vitro trial

PurposeTo evaluate the influence of implant scanbody (ISB) material, position and operator on the accuracy of a confocal microscopy intraoral scanning (IOS) for complete-arch implant impression.MethodsAn edentulous maxillary model with 6 internal hexagonal connection analogues was scanned with an extraoral optical scanner to achieve a reference file. Three ISBs made of different materials (polyetheretherketone (Pk), titanium (T) and Pk with a titanium base (Pkt)) were scanned with IOS by 3 operators. The resulting 45 test files were aligned to the reference file with a best fit algorithm. Linear (ΔX, ΔY and ΔZ-axis) and angular deviations (ΔANGLE) were assessed. Absolute values of the linear discrepancies were summed up to obtain a global measure of linear absolute error (ΔASS). Influence of ISB material, position and operator was statistically assessed using the mixed general linear model.ResultsAt multivariate analysis, whenΔASS was considered as response variable, it was identified a significant influence of material (p < 0.0001) and position (p = 0.0009) while no significant operator effect was detected.When ΔANGLE was considered as response variable, material and position significantly influenced the expected ΔANGLE (p = 0.0232 and p < 0.0001) and no operator effect was identified.ConclusionsThe investigated IOS for complete-arch digital impression was influenced by the ISB material with peek reporting the best results on both linear and angular measurements followed by titanium, peek-titanium resulting as the less accurate. Implant angulation affected significantly the linear deviations while implant position the angular deviations. Operator did not show any significant effect on the IOS accuracy.     

Comparison of a quantitative Real-Time PCR assay and droplet digital PCR for copy number analysis of the CCL4L genes

The controversy surrounding the findings that copy number variation, of the CCL3 encoding genes, influences HIV-1 infection and disease progression has been in part attributed to the variable results obtained from methods used for copy number evaluation. Like CCL3, the genes encoding the CC chemokine CCL4, also a natural ligand of the CCR5 receptor, are found to occur in population-specific multiple copy number and have been shown to play a protective role against HIV-1. This study evaluated the standard method of quantitative Real-Time PCR (qPCR) and droplet digital PCR (ddPCR) for CCL4L gene copy number determination. The CCL4 encoding genes are CCL4, occurring in two copies per diploid genome (pdg), and the non-allelic CCL4L genes, comprised of CCL4L1 and CCL4L2, which are both found in multiple copies pdg. Copy number of CCL4L, CCL4L1 and CCL4L2 was determined in a cohort of HIV-1-uninfected individuals from the South African Black (n = 23) and Caucasian (n = 32) population groups using qPCR and ddPCR. A stronger correlation between the number of CCL4L copies and the sum of CCL4L1 and CCL4L2 copies generated by ddPCR (r = 0.99, p < 0.0001) compared to qPCR (r = 0.87, p < 0.0001) was observed. Real-Time qPCR exhibited greater inaccuracy at higher copy numbers which is particularly relevant to our cohort of Black individuals who have a higher range of CCL4L copies (3–6) compared to Caucasians (0–4) and a higher population median (4 and 2, respectively). Medians and ranges of CCL4L1 (Black: 2, 0–4, Caucasian: 0, 0–2) and CCL4L2 (Black: 2, 1–5, Caucasian: 2, 0–3) were also higher in the Black population. Droplet digital PCR was shown to be a far superior method to qPCR for assessment of CCL4 gene copy number variation, the accuracy of which is essential for studies of the contribution of variable gene copy number to phenotypic outcomes of host infection and disease course.     

Internet-delivered psychoeducation for older adolescents and young adults with autism spectrum disorder (SCOPE): An open feasibility study

BackgroundThere is a paucity regarding interventions in general, and especially internet-delivered treatment options, for adolescents and young adults with autism spectrum disorder (ASD), despite the group´s capacity and willingness to utilize computer-mediated communication. This open feasibility study evaluated the new internet-delivered, psychoeducational intervention, SCOPE (Spectrum COmputerized PsychoEducation), for adolescents and young adults aged 16–25 years with ASD in the normative IQ range.MethodThe participation in SCOPE was facilitated by weekly contacts with disability service professionals (trained coaches) and the intervention consisted of eight ASD-themed modules. In an open feasibility study we evaluated treatment completion, treatment credibility and satisfaction, as well as preliminary efficacy. We assessed feasibility in an outpatient disability services context, regarding both participants’ and coaches’ experiences.ResultsTwenty-three out of the 29 included participants (79%) completed the intervention. The participants’ experience of treatment credibility was increased during the SCOPE web course and the overall satisfaction with the treatment was high. The coaches reported high treatment credibility and good clinical feasibility of the internet-based delivered intervention. The participants’ knowledge of ASD increased significantly from pre-intervention to post-intervention. The increased knowledge of ASD was not associated with negative effects on psychological well-being.ConclusionsOur results suggest that the internet-delivered psychoeducational intervention SCOPE is a feasible intervention and could contribute to youth’s sense of empowerment through increased knowledge of ASD and themselves. An ongoing randomized controlled study will generate further evidence concerning the SCOPE intervention.