BACKGROUND Hospital hyperglycemia is common and associated with potential adverse outcomes. A Hospital-wide Mobile Phone Alert (HMA) system was built to achieve real time glucose monitoring with warnings for glucose excursions. This study investigated the status of glucose control and evaluated the impact of HMA system on inpatient glycemia management. METHODS Inpatients with hyperglycemia hospitalized between 1 January, 2017 and 31 December, 2018 were identified excluding those < 18 years of age. The HMA system was activated on 1 October, 2017. It sent real time cellphone warning messages to the patient’s designated team physician whenever glucose levels > 10 mmol/L or < 3 mmol/L were detected. A serum glucose > 7.8 mmol/L was defined as hospital hyperglycemia (HH), and > 10 mmol/L was defined as significant HH (SHH). Glucose excursions before and after the HMA system was instituted were compared. RESULTS The incidence of HH, SHH and hypoglycemia was 26.1%, 12.8% and 2.5%, respectively. With the HMA system, the monthly glucose related consultation rate for all inpatients increased 65.9%. The rate of HH glucose amount/ total glucose amount improved with the HMA system, being lower than pre HMA system activation for the surgical wards (15.8 ± 4.7% vs 21.1 ± 6.1%，p<0.05). CONCLUSIONS In this study, one third of inpatients were noted to experience hyperglycemia. Real time cellphone warning messages to the patient’s designated team physician can improve consultation utilization for blood glucose excursions. The alert system was found to reduce the incidence of hyperglycemia on surgical wards.

Introduction: Metformin has been demonstrated to enhance cardioprotective benefits in type 1 diabetes(T1DM). Although glycemic variability (GV) is associated with increased risk of CVD in diabetes, there is a scarcity of research evaluating the effect of metformin on GV in T1DM. Objectives: In the present study, the effects of adjuvant metformin therapy on GV and metabolic control in T1DM were explored. Patients and methods: A total of 65 adults with T1DM were enrolled and subjected to physical examination, fasting laboratory tests and continuous glucose monitoring, and subsequently randomized 1:1 to 3 months of 1000- 2000 mg metformin daily add-on insulin (MET+INS, n=34) or insulin (INS, n=31). After, baseline measurements were repeated. Results: The mean amplitude of glycemic excursions was substantially reduced in the MET+INS group, compared with the INS group (-1.47±3.39 mmol/L versus 1.05±4.24 mmol/L, P=0.012). In parallel, the largest amplitude of glycemic excursions (-2.28±4.71 mmol/L versus 1.77±5.71 mmol/L, P=0.003), the standard deviation of blood glucose (- 0.62±1.15 mmol/L versus 0.08±1.23 mmol/L, P=0.023), and the coefficient of variation (-6.08±12.31 % versus 2.29±11.57 %, P=0.008) all demonstrated improvement in the MET+INS group, compared with the INS group. Significant reduction in the insulin dose, body mass index and body weight were observed in patients with MET+INS, not those with INS. Conclusion: Additional metformin therapy improved GV in adults with T1DM, as well as improving body composition and reducing insulin requirement. Hence, metformin as adjunctive therapy has potential prospects in reducing the CVD risk in patients with T1DM in the long term.

Background: Diabetes mellitus and periodontal disease are global epidemic ailment with severe health consequences. The literature regarding medical-healthcare professionals’ knowledge, attitude, and practices regarding periodontal-diabetes disease link from Australia is missing. Methods: A convenience sample of medical-healthcare professionals participated in the study to complete an 18-item questionnaire. An online survey was designed to investigate the knowledge and understanding of the periodontal disease (gingivitis and periodontitis) and the link between periodontal disease and diabetes mellitus. Results: A total of 46 medical professionals completed the survey. The results of the pilot study demonstrated higher understanding and awareness of the bidirectional relationship between diabetes mellitus and periodontal disease among this cohort of medical professionals. The majority of the medical practitioners (89%) knew that the glycemic index of persons living with diabetes (having periodontal disease) could be improved by providing periodontal therapy. Conclusion: It can be concluded that the investigated cohort is aware of the association between periodontal disease and diabetes mellitus. However, this knowledge is not reflected in their clinical practice resulting in a low frequency of referral and communication with the dentist. It is the time medical professionals should realise the fact that “No health without oral health”.

Bovine tuberculosis (bTB) challenges intensive dairy production in Ethiopia and implementation of the test and slaughter control strategy is not economically acceptable in the country. Vaccination of cattle with Bacillus Calmette-Guerin (BCG) could be an important adjunct to control, which would require a diagnostic test to differentiate Mycobacterium bovis (M. bovis)-infected and BCG-vaccinated animals (DIVA role). This study describes evaluation of a DIVA skin test (DST) that is based on a cocktail (DSTc) or fusion (DSTf) of specific (ESAT-6, CFP-10 and Rv3615c) M. bovis proteins in Zebu-Holstein crossbred cattle in Ethiopia. The study animals used were 74 calves (35 BCG-vaccinated and 39 unvaccinated) aged less than three weeks at the start and 68 known bTB positive cows. Six weeks after vaccination, the 74 calves were tested with DSTc and the single intradermal cervical comparative tuberculin (SICCT) test. The cows were tested with DSTc and SICCT test. Reactions to DSTc were not observed in BCG-vaccinated and unvaccinated calves while SICCT test reactions were detected in vaccinated calves. DSTc reactions were detected in 95.6% of the cows and single intradermal tuberculin (SIT) positive reactions were found in 98.2% (95% confidence interval, CI, 92.1–100%). The sensitivity of DSTc was 95.6% (95% CI, 87.6–99.1%), and significantly (P<0.001) higher than the sensitivity (75%, 95% CI, 63.0-84.7%) of the SICCT test at 4mm cutoff. DSTf and DSTc reactions were correlated (r = 0.75; 95% CI =0.53–0.88). In conclusion, DSTc could differentiate M. bovis-infected from BCG-vaccinated cattle in Ethiopia. DST had higher sensitivity than the SICCT test. Hence, DSTc could be used as a diagnostic tool for bTB if BCG vaccination is implemented for the control of bTB in Ethiopia and other countries.

This paper investigated the effect of shot-peening on fatigue strength of spring steel for the high cycle fatigue (HCF) and very high cycle fatigue (VHCF) to clarify the fatigue limit behavior of high strength spring steel during service life. Hourglass shape specimens made of spring steel (Si-Cr alloys) were prepared for the rotary bending fatigue test. Actual local stresses were quantitatively calculated to compensate for the stress amplitudes, through which it was clarified that the shot-peening had strongly positive effects on the HCF strength, but rather negative effect on the VHCF strength. The fish-eye fracturing process confirmed that most fish-eye fractures arose at sites deeper than the compressive residual stress zone, which did not prevent the creation of the fish-eye, and the fatigue strength improvement in the VHCF range could scarcely be shown as a result of the shot-peening treatment.

Following the emergency use authorization of the vaccine mRNA-1273 on 18th December 2020 in the US and the vaccine BNT162b2 one week earlier, two mRNA vaccines are in currently used for the prevention of coronavirus disease 2019 (COVID-19). Phase 3 pivotal trials on both vaccines excluded individuals with a history of allergy to vaccine components. Immediately after the initiation of vaccination in the United Kingdom, Canada, and in the US, anaphylactic reactions have been reported. While the culprit trigger requires investigation, initial reports suggested the excipient polyethylene glycol 2000 (PEG-2000), which is contained in both vaccines as PEG-micellar carrier system as the potential culprit. Surface PEG chains form a hydrate shell to increase stability and prevent opsonization. Allergic reactions to such PEG-ylated lipids are rarely IgE-mediated, but may result from complement activation-related pseudoallergy (CARPA) that has been described to similar liposomes. In addition, mRNA-1273 also contains tromethamine (trometamol), which has been reported to cause anaphylaxis to e.g. gadolinium-based or iodinated contrast media. Skin prick-, intradermal-, epicutaneous- tests, in vitro sIgE assessment, evaluation of sIgG/IgM, as well as basophil activation test are in use to demonstrate allergic reactions to various components of the vaccines.

Background: Two-dimensional speckle tracking echocardiography (STE) is a quantitative myocardial strain imaging technique in evaluating global and segmental myocardial deformation. The aim of the meta-analysis was to determine the diagnostic accuracy of STE in the detection of significant coronary artery disease (CAD) in patients undergoing resting or stress echocardiography. Methods: We performed a literature search in PubMed and Medline until March 2020 for studies evaluating the role of STE in diagnosing CAD. We assessed the diagnostic performance of STE in detecting CAD by using the pooled estimate of sensitivity, specificity, likelihood ratio, diagnostic odds ratio and diagnostic accuracy. We analyzed longitudinal strain data that were reported in resting and stress echocardiography. Results: A total of 17 studies (n=1762) were included for the analysis. 12 studies (n=1239) reported global longitudinal strain (GLS) in resting echocardiography and 5 studies (n=523) reported GLS in stress echocardiography. Overall, in resting echocardiography studies, pooled GLS sensitivity and specificity for predicting obstructive CAD data were calculated to be 79% (95% confidence interval 74-83%) and 77% (95% confidence interval 72-82%), respectively. The pooled odds ratio was 13.6 (95% confidence interval 8.7-21.5). When we considered the dobutamine stress echocardiograms alone, the sensitivity and specificity in predicting obstructive CAD was 77% (95% confidence interval 59-89%) and 78% (95% confidence interval 53-92%), respectively. The odds ratio was 12.6 (95% confidence interval 2.7-58.5). Conclusions: In this meta-analysis of patients with suspected CAD, we found that STE could effectively detect obstructive CAD with a high diagnostic sensitivity, specificity and diagnostic accuracy

In this paper, we consider the Space-Time Fractional Advection-Dispersion equation on a finite domain with variable coefficients. Fractional Advection- Dispersion equation as a model for transporting heterogeneous subsurface media as one approach to the modeling of the generally non-Fickian behavior of transport. We use a semi-analytical method as Reproducing kernel Method to solve the Space-Time Fractional Advection-Dispersion equation so that we can get better approximate solutions than the methods with which this problem has been solved. The main obstacle to solve this problem is the existence of a Gram-Schmidt orthogonalization process in the general form of the reproducing kernel method, which is very time-consuming. So, we introduce the Improved Reproducing Kernel Method, which is a different implementation for the general form of the reproducing kernel method. In this method, the Gram-Schmidt orthogonalization process is eliminated to significantly reduce the CPU-time. Also, the present method increases the accuracy of approximate solutions.

Rationale: Gas exchange abnormalities in Sickle Cell Disease (SCD) may represent cardiopulmonary deterioration. Identifying predictors of these abnormalities in children with SCD (C-SCD) may help us understand disease progression and develop informed management decisions. Objectives: To identify pulmonary function tests (PFT) and biomarkers of systemic disease severity that are associated with and predict abnormal carbon monoxide diffusing capacity (DLCO) in C-SCD. Methods: We obtained PFT data from 51 C-SCD (115 observations) and 22 controls, and identified predictors of DLCO for further analyses. We formulated a rank list of DLCO predictors based on machine learning algorithms (XGBoost) or linear mixed-effect models and compared estimated DLCO to the measured values. Finally, we evaluated the association between measured and estimated DLCO and clinical outcomes, including SCD crises, pulmonary hypertension, and nocturnal hypoxemia. Results: DLCO and several PFT indices were diminished in C-SCD compared to controls. Both statistical approaches ranked FVC%, neutrophils(%), and FEV25%-75% as the top three predictors of DLCO. XGBoost had superior performance compared to the linear model. Both measured and estimated DLCO demonstrated significant association with SCD severity indicators. DLCO estimated by XGBoost was associated with SCD crises (beta=-0.084 [95%CI -0.134, -0.033]) and with TRJV (beta=-0.009 [-0.017, -0.001]), but not with nocturnal hypoxia (p=0.121). Conclusions: In this cohort of C-CSD, DLCO was associated with PFT estimates representing restrictive lung disease (FVC%), airflow obstruction (FEV25%-75%), and inflammation (neutrophil%). We were able to use these indices to estimate DLCO, and show association with disease outcomes, underscoring the prediction models’ clinical relevance.

This paper is a review of the southwest Nigerian Yorùbá and their recognized peacefulness in the context of Nigeria as a country. It attempts to address the peacefulness amidst the Nigeria unstable circumstances and in comparison, with the established peaceful societies (PS). The first part of the paper provides a concise discussion about peace and conflict studies as it developed in the West followed by an outline of conflicts in Nigeria and amongst the Yorùbá to identify a gap for this inquiry. The paper suggests the Yorùbá multireligious community provides some clues to how peacefulness could be retained in a society. Similarly, it suggests the roles informal peace education play in supporting people of different beliefs but same culture to retain their harmony. The author, nevertheless, left a challenge to move the study of PS beyond the agrarian and rural communities to investigate more modern societies for peacefulness. NOTE: This article is taken from part of chapter 2 and the conclusion of the author’s doctoral thesis, with a few amendments.

Abrupt changes in climatic factors, exploitation of natural resources, and land degradation contribute to soil erosion. This study provides the first comprehensive analysis of annual soil erosion dynamics in Pakistan for 2005 and 2015 using publically available climatic, topographic, soil type, and land cover geospatial datasets at 1 km spatial resolution. A well-accepted and widely applied Revised Universal Soil Loss Equation (RUSLE) was implemented for the annual soil erosion estimations and mapping by incorporating six factors; rainfall erosivity (R), soil erodibility (K), slope-length (L), slope-steepness (S), cover management (C) and conservation practice (P). We used a cross tabular or change matrix method to assess the annual soil erosion (ton/ha/year) changes (2005-2015) in terms of areas and spatial distriburtions in four soil erosion classes; i.e. Low (<1), Medium (1–5], High (5-20], and Very high (>20). Major findings of this paper indicated that, at the national scale, an estimated annual soil erosion of 1.79 ± 11.52 ton/ha/year (mean ± standard deviation) was observed in 2005, which increased to 2.47 ±18.14 ton/ha/year in 2015. Among seven administrative units of Pakistan, in Azad Jammu & Kashmir, the average soil erosion doubled from 14.44 ± 35.70 ton/ha/year in 2005 to 28.03 ± 68.24 ton/ha/year in 2015. Spatially explicit and temporal annual analysis of soil erosion provided in this study is essential for various purposes, including the soil conservation and management practices, environmental impact assessment studies, among others.

Invasion in cardiac surgery is maximum when cardiopulmonary bypass(CPB) is used. The period is of no consequence as all complications such as Bleeding, Cerebral. Renal , vascular and Inflammatory responses are initiated when CPB is used. The term minimally invasive is therefore most inappropriate when CPB is used irrespective of the type of operation, incision, cosmesis, and use of sophisticated technology.This editorial highlights the misuse of the term Minimally invasive cardiac surgery.

Background: Post-ischemic inflammation contributes to worsening of ischemic brain injury and in this process, the inflammasomes play a key role. Inflammasomes are cytosolic multiprotein complexes which upon assembly activate the maturation and secretion of the inflammatory cytokines IL-1β and IL-18. However, participation of the NLRP3 inflammasome in ischemic stroke remains controversial. Our aims were to determine the role of NLRP3 in ischemia and to explore the mechanism involved in the potential protective effect of the neurovascular unit. Methods: WT and NLRP3 knock-out mice were subjected to ischemia by middle cerebral artery occlusion (60 minutes) with or without treatment with MCC950 at different time points post-stroke. Brain injury was measured histologically with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Results: We identified a time-dependent dual effect of NLRP3. While neither the pre-treatment with MCC950 nor the genetic approach (NLRP3 KO) proved to be neuroprotective, post-reperfusion treatment with MCC950 significantly reduced the infarct volume in a dose-dependent manner. Importantly, MCC950 improved the neuro-motor function and reduced the expression of different pro-inflammatory cytokines (IL-1β, TNF-α), NLRP3 inflammasome components (NLRP3, pro-caspase-1), protease expression (MMP9) and endothelial adhesion molecules (ICAM, VCAM). We observed a marked protection of the blood-brain barrier (BBB), which was also reflected in the recovery of the tight junctions proteins (ZO-1, Claudin-5). Additionally, MCC950 produced a reduction of the CCL2 chemokine in blood serum and in brain tissue, which lead to a reduction in the immune cell infiltration. Conclusions: These findings suggest that post-reperfusion NLRP3 inhibition may be an effective acute therapy for protecting the blood-brain barrier in cerebral ischemia with potential clinical translation.

Finding effective anchoring materials for the immobilization of soluble lithium polysulfides to suppress the shuttling effect has become the key to large-scale application of lithium-sulfur (Li–S) batteries. In this work, the potentials of group-VA two-dimensional (2D) materials including arsenene, antimonene and bismuthene (As, Sb and Bi monolayers) as Li-S battery cathode anchoring materials were systematically investigated by density functional theory (DFT) calculations. The adsorption energies of sulphur (S8) and various lithium polysulfides (Li2Sn, n = 8, 6, 4, 2, 1), as well as the diffusion energy barriers for long-chain Li2S4 and Li2S6 on these three monolayers were studied in detail. The calculated moderate adsorption energies of these monolayers to all polysulfides imply that they can effectively inhibit the shuttling effect. The favorable diffusion barriers for Li2S4 and Li2S6 ensure the efficient diffusion of polysulfides on monolayer surface. In addition, these 2D materials can keep a balance between the binding strength and the structural integrity of polysulfides. The presented merits demonstrate that As, Sb and Bi monolayers can be the promising cathode anchoring materials to improve the performance of Li-S batteries.

Leishmania donovani is the causative agent of historically anthroponotic visceral leishmaniasis (VL) on the Indian subcontinent (ISC). L. donovani is transmitted by the sand fly species Phlebotomus argentipes. Our collaborative group and others have shown that sand flies trapped outside in endemic villages have fed on cattle and dogs in addition to people. Domestic animals are reservoirs for L. donovani complex spp., particularly L. infantum, in other endemic areas. Multiple studies using quantitative PCR or serological detection methods have demonstrated that goats, cattle, rats and dogs were diagnostically positive for L. donovani infection or exposure in eastern Africa, Bangladesh, Nepal and India. There is a limited understanding of the extent to which L. donovani infection of domestic animals drives transmission to other animals or humans on the ISC. Evidence from other vector-borne disease elimination strategies indicated that emerging infections in domestic species hindered eradication. The predominant lesson learned from these other situations is that non-human reservoirs must be identified, controlled and/or prevented. Massive efforts are underway for VL elimination on the Indian subcontinent. Despite these herculean efforts, residual VL incidence persists. The specter of an animal reservoir complicating elimination efforts haunts the final push toward full VL control. Better understanding of L. donovani transmission on the Indian subcontinent and rigorous consideration of how non-human reservoirs alter VL ecology are critical to sustain elimination goals.

Current results do not provide conclusive evidence on the effect of BCG vaccination on COVID-19 alone or in combination with other factors. To address this limitation, in this study we used a citizen science initiative on the COVID-19 pandemic to collect data worldwide during October 2-30, 2020 (1,233 individuals) in a structured way for analyzing factors and characteristics of affected individuals in relation to BCG vaccination. For the first time, the results of our study suggested that vaccination with BCG may increase the risk for COVID-19 at certain age, particularly in individuals vaccinated at childhood. A reasonable explanation for this effect is the activation of certain innate immunity mechanisms associated with inflammatory reactions, which should be considered when analyzing the risks associated with this global pandemic. These factors should be considered when analyzing the risks associated with this global pandemic.

Several plastic degrading enzymes have been described in the literature, most notably PETases that are capable of hydrolyzing polyethylene terephthalate (PET) plastic. One of them, the PETase from Ideonella sakaiensis, a bacterium isolated from environmental samples within a PET bottle recycling site, was the subject of extensive studies. To test how widespread PETase functionality is in other bacterial communities, we used a cascade of BLAST searches in the JGI metagenomic datasets and showed that PETases can also be found in other metagenomic environmental samples from both human affected and relatively pristine sites. To confirm their classification as PETases, we verified that the newly identified proteins have the PETase sequence signatures common to all PETases and that phylogenetic analyses group them with the experimentally characterized PETases. Additionally, docking analysis was performed in order to further confirm the functional assignment of the putative environmental PETases.

Fatigue failure is the most common failure mode of structural materials. In this study, the high-cycle fatigue properties at different temperatures, fracture surface morphologies and corresponding damage mechanisms of a widely used vermicular graphite cast iron RuT450 were investigated. It is found that the fatigue strength of RuT450 decreases with the increase of temperature, and the decreasing rate is affected by the change of morphology and content of graphite. In general, the cracks initiated from the graphite phase boundary and propagated through the pearlite lamellae. In addition, according to the change of matrix micro-structure and the slight change of graphite morphology at different temperatures, and combined with the change of crack propagation threshold value under different temperature conditions, a fatigue strength prediction method for vermicular graphite cast iron at different temperatures was proposed in this work, which has high prediction accuracy.

Epilepsy is a common neurological disorder characterized by repeated and spontaneous epileptic seizures, which is not well controlled by current medication. Traditional theory supports that epilepsy results from the imbalance of excitatory glutamate neurons and inhibitory GABAergic neurons. Recently, shreds of evidence from available clinical and preclinical researches suggest that histamine in the central nervous system plays an important role in the modulation of neural excitability and pathogenesis of epilepsy. Many histamine receptor ligands show positive response in animal epilepsy models, among which the H3R antagonist pitolisant even has shown a good anti-epileptic effect in clinical trials. New insights are focusing on the potential action of histamine receptors to control and treat epilepsy. This review summarizes the findings from animal and clinical researches on the role of brain histamine and histamine receptor in epilepsy. Importantly, we further provide perspectives on some possible research directions for future studies.

Le radiazioni sono un fenomeno di emissione di energia sotto forma di onde, quest'ultime possono essere: luminose, elettromagnetiche o sonore. Le onde elettromagnetiche vengono distinte, in funzione della frequenza e dell'energia,in radiazioni ionizzanti e radiazioni non ionizzanti.Le radiazioni ionizzanti sono dotate di un'energia sufficiente a liberare elettroni da atomi, mentre le radiazioni non ionizzanti sono radiazioni elettromagnetiche che non trasportano sufficiente energia per ionizzare atomi e producono principalmente effetti termici.Nel caso studio da noi analizzato evidenziamo un'importante questione da affrontare: il monitoraggio delle fonti di emissione. Quest'aspetto è diventato sempre più rilevante poiché siamo costantemente immersi in campi generati dai dispositivi elettronici. Lo scopo finale di tale indagine è sia quello di evidenziare eventuali problemi per la salute dei cittadini sia quello di descrivere il quadro normativo vigente in materia e le fasi metodologiche per l'analisi di questo comaparto in fase di redazione di Studio d'Impatto Ambientale.  

Kayexalate® is associated with gastrointestinal injury that can be fatal. Physicians must be aware of the adverse events when prescribing this therapy. Clinical data and medication history should follow the biopsy material given to the pathologist, who will look for Kayexalate® crystals. Pathologists and physicians should work hand in hand.

BOOK REVIEW: Technical Aspects of Modern Coronary Artery BypassRobert F Tranbaugh, MDDepartment of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NYData Availability: NAFunding: NoneConflict of Interest: NoneInternational Review Board: NAInformed Consent: NACorresponding author:Robert F Tranbaugh, MDDepartment of Cardiothoracic SurgeryWeill Cornell Medicine505 East 68th StreetNew York, NY 10065Rft9008@med.cornell.eduWord Count: 484After recently purging most of my reference textbooks (many from the 1970’s and 1980’s and including the big names from the “Golden Age” of cardiac surgery—Glenn, Sabiston and Kirklin), I wondered if the era of the well-recognized, authoritative textbook was over. I actually cannot remember the last textbook I purchased. While a resident at UCSF, textbooks were critically important as the library closed at midnight. I grew up with the “red book”, Dunphy and Way’s “currentSurgical Diagnosis and Treatment”. This paperback nicely covered the basics of surgery and, importantly, was readily available for residents well before Google. Primarily for sentimental reasons, I kept my 1983 edition.So, why a surgical textbook in 2021? What is the appeal, attraction and need?Gaudino’s “Technical Aspects of Modern Coronary Artery Bypass Grafting” has enormous appeal. For one, it is beautifully illustrated with very useful drawings along with attractive and detailed operative photos. At times, I felt like I was visiting the author-surgeon in his or her operating room. The world’s leading experts have provided detailed step by step technical instructions, which are clear, concise and very helpful. For cardiac surgeons considering starting a multiple arterial grafting (MAG) program, this textbook is a needed and wonderful resource.The attractions of Gaudino’s testbook are many. First, “Technical Aspects” clearly reflects Gaudino’s stellar and highly productive career as an investigator and practitioner of MAG. He has systematically addressed the details of MAG. Conduit selection, harvest and utilization are all outlined in exquisite step by step detail. Complex grafting techniques are reviewed and beautifully illustrated. I especially enjoyed Chapter 12 by Rocha and his colleagues on their nicely done essay on the proximal anastomosis, or what I consider to be “the forgotten anastomosis”. The authors review the many important technical details and critical issues impacting the patency of a bypass graft.All of the chapters are well written, beautifully illustrated, highly practical and very helpful for residents in training, for early career surgeons and for well-established cardiac surgeons interested in coronary artery bypass. Gaudino should also be commended for the addition of Chapter 23 by Fremes and Tatoulis on the management of perioperative ischemia and Chapter 24 by Lazar on optimizing medical therapy. These are incredibly important chapters on “non-technical” yet critical issues with excellent recommendations.Gaudino’s “Technical Aspects” is a clearly needed and a highly authoritative textbook which will serve as an excellent roadmap for surgeons interested in starting a MAG program. It hopefully will allow surgeons to move from the “house special” CABG (one internal mammary and veins) mentioned by Girardi in his thoughtful Foreward to more arterial grafting performed with greater confidence and commitment. “Technical Aspects” will also serve as an important resource for surgeons at all levels of training and expertise. I currently have lots of room on my near empty book shelf. “Technical Aspects” will be on my book shelf and belongs on yours!

Mitral valve (MV) repair for mitral regurgitation (MR) due to posterior leaflet (PL) prolapse is achieved nowadays with a great success rate and a good survival, similar, in certain subgroups. In this paper, Sakaguchi et al describe their results in two groups of patients with PL prolapse. Some patients underwent resection (resection group) and others chordal replacement with/out limited resection (respect group). Results were similar in terms of survival and MR recurrence. Our goal is to eliminate, as much as possible, MR when a patient with degenerative MR is operated on. Reduction of the mitral orifice and consequently an increase of the transmitral gradient is the rule. MV repair for degenerative MR provides great results, but there is not a single surgical technique. A close evaluation of the anatomical findings will allow us to choose the best strategy for the individual patient. An open mind is the most important characteristic that a surgeon should have to repair a prolapsing PL without residual regurgitation and dangerous gradients.

Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.