Outcomes in techniques of valve sparing aortic root replacement: A systematic review and meta-analysis

OBJECTIVE

To compare clinical outcomes of reimplantation versus remodeling in patients undergoing valve-sparing aortic root replacement (VSRR) surgery.

METHOD

Electronic database search at PubMed, Scopus, Embase, Ovid, and Google scholar was performed from inception to January 2020. Primary outcomes were aortic valve (AV) reintervention and postoperative grade of aortic insufficiency (AI) while secondary outcomes were 30-day mortality, reoperation for bleeding, and operative times.

RESULTS

A total of 21 articles met the inclusion criteria. A total of 1283 patients had reimplantation while 1150 had remodeling. No difference in preoperative demographics was noted except reimplantation patients were younger (48 ± 16 vs. 56 ± 15 years; p < .00001). The cardiopulmonary bypass and aortic cross-clamp times were shorter in the remodeling cohort (168 ± 38 vs. 150 ± 37 min; p = .0001 and 133 ± 31 vs. 112 ± 30 min; p = .0002, respectively). No difference in concomitant total arch surgery (14% in reimplantation vs. 15% in remodeling; p = .53). Postoperatively, there were similar stroke rates (3% in both cohorts; p = .54), rates of reoperation for bleeding (9% in reimplantation vs. 12% in remodeling; p = .88), and 30-day mortality (3% in reimplantation vs. 4% in remodeling; p = .96). No difference in early AV reintervention (1% in reimplantation vs. 2% in remodeling; p = .07), and late AV reintervention (4% in reimplantation vs. 7% in remodeling; p = .07). The AI of +2 grade was significantly lower in the reimplantation cohort (5% vs. 8%; p = .01).

CONCLUSION

Our study shows comparable clinical outcomes between both techniques. The practice of each technique is largely center and surgeon dependent. Larger sample size cohorts with minimal confounding factors are required to confirm the above findings.

Additive Manufacturing of Sub-Micron to Sub-mm Metal Structures with Hollow AFM Cantilevers

We describe our force-controlled 3D printing method for layer-by-layer additive micromanufacturing (µAM) of metal microstructures. Hollow atomic force microscopy cantilevers are utilized to locally dispense metal ions in a standard 3-electrode electrochemical cell, enabling a confined electroplating reaction. The deflection feedback signal enables the live monitoring of the voxel growth and the consequent automation of the printing protocol in a layer-by-layer fashion for the fabrication of arbitrary-shaped geometries. In a second step, we investigated the effect of the free parameters (aperture diameter, applied pressure, and applied plating potential) on the voxel size, which enabled us to tune the voxel dimensions on-the-fly, as well as to produce objects spanning at least two orders of magnitude in each direction. As a concrete example, we printed two different replicas of Michelangelo's David. Copper was used as metal, but the process can in principle be extended to all metals that are macroscopically electroplated in a standard way.

Fibromyalgia in biblical times

Although fibromyalgia (FM) is now a recognized clinical entity, an early description of this clinical syndrome is found in the Old Testament. In this Letter, biblical passages which are mentioned to the main symptoms of FM (e.g. chronic and disabling pain, unrefreshing sleep and physical exhaustion), actually associated with chronic stress and depression, are presented indicatively.

Stigma and the addiction paradigm for obesity: lessons from 1950s America

AIMS

To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today.

METHODS

Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s.

RESULTS

In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesity's consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected.

CONCLUSIONS

Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States.