A critical review of surgical strategies to minimise venous stenosis in arteriovenous grafts

It is inevitable that complications arising from surgical procedures are ascribed to surgical technique, and this applies to venous stenosis (VS) in arteriovenous grafts. However, despite a wide range of cellular studies, computer modelling, observational series and clinical trials, there remains uncertainty on whether surgical technique contributes to VS. This article reviews evidence from basic science, fluid dynamics and clinical data to try and rationalise the main surgical options to modify the occurrence of venous stenosis. There is sufficient data from diverse sources to make recommendations on clinical practice (size of target vein, shape of anastomosis, angle of approach, distance from venous needling, trauma to the target vein) whilst at the same time this emphasises the need to carefully report the practical aspects of surgical technique in future clinical trials.

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.

Medical Waste Due to Intravitreal Injection Procedures in a Retina Clinic

Purpose: Medical waste contributes to health care costs and has a direct negative impact on the environment. The goals of this study are to quantify and categorize the medical waste generated by intravitreal injection procedures and identify opportunities to reduce waste. Methods: This is a prospective observational series. Medical waste from intravitreal injections was collected from 337 consecutive intravitreal injections by a retina specialist over 2 weeks. The waste was sorted, photographed, weighed, and recorded. Results: A total of 65.6 kg of waste was collected across 3 broad categories: (1) shipping waste (cardboard boxes, foam coolers, cold packs, and bubble wrap); (2) waste from administering the intravitreal injection (nitrile gloves, tissues, wipes, and plastic or paper packaging); and (3) biohazard waste (used syringes and needles). Shipping waste contributed 83% of the overall waste, by mass, and varied greatly based on the size of the order and how efficiently shipments were packed. Cold packs, foam coolers, cardboard/paper, and nitrile gloves were the greatest contributors to carbon emissions and landfill. Conclusions: Waste due to shipping of medication is a major opportunity for reducing the environmental impact of intravitreal injections. Buying in bulk is a simple way for retina practices to reduce waste. Manufacturers should consider less bulky packaging for branded intravitreal injections; distributors and outsourcing facilities should consider take-back programs to reuse coolers and cold packs. Improved sustainability in the treatment of retinal disease is achievable but requires awareness and optimization of a clinic’s routine.

To issue of gorges and ice jams in the Kuban river basin

Purpose: analysis of quantitative indicators of actual сongestion and ice jams in the Kuban river basin with subsequent intra-basin zoning of the parameters studied. Materials and Methods: data from hydrometeorological observations of ice phenomena were used. The summary calculation of the quantitative indicators of gorges and ice jams along the river Kuban, as well as for each basin of tributaries of the first order was carried out. Results: as a result of the analysis, it was found that the cases of maximum ice jams above the “0” graph in the river Kuban basin were observed more often than the maximum gorge rises. On the river Kuban the number of jams was 90, gorges – 64; in the river Belaya basin number of jamming phenomena was 96, gorges – 9; in the river Laba basin – 43 ice jams and 18 gorges; on the river Pshish the number of jams – 31, gorges – 6; in the river basin Urup the number of jams is 10, and the number of gorges is 20; the river Bolshoi Zelenchuk basin has 25 jams, and 5 gorges. The maximum rise in the water level during jams was 248 cm on the river Pshish at the Bzhedukhovskaya gauging station. The highest water level during gorge events was also recorded on the river Pshish in the aul Teuchezhkhabl and amounted to 386 cm. Most of the recorded cases of water level rise in the presence of gorge phenomena occur at the end of December and the second decade of February. There are no observational series of gorge events at most gauging stations, but, according to available data, most gorge events occur at the end of January and the second decade of February. Conclusions: gorges and ice jams are very dangerous natural phenomena and therefore require promptness and accuracy of forecasting. The solution of such problems is impossible without a network of hydrological posts and observation points, which is currently underdeveloped. Therefore, thickening and improving the existing observational network is one of the main solutions to this issue.

Outcome of complete acellular dermal matrix wrap with polyurethane implant in immediate prepectoral breast reconstruction

Background Polyurethane implants have been used on and off in breast reconstruction since 1991 while prepectoral breast reconstruction has gained popularity in recent times. In this study, we present our outcomes from the use of acellular dermal matrix (ADM) complete wrap with polyurethane implants in prepectoral breast reconstruction.Methods This is a retrospective review of prospectively maintained database from 41 patients receiving complete ADM wrap with prepectoral polyurethane implants over a 3-year period. Selection criteria were adapted from a previous study (4135 Trust Clinical Audit Database) evaluating prepectoral reconstruction with Braxon matrices. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed.Results A total of 52 implant reconstructions were performed in 41 patients with a mean follow-up of 14.3 months (range, 6–36 months). The overall reported complication rates including early (less than 6 weeks) and late complications. Early complications included two patients (4.9%) with wound dehiscence. One of which had an implant loss that was salvageable. Another patient (2%) developed red-breast syndrome and two women (4.9%) developed with seroma treated conservatively. Late complications included one patient (2%) with grade II capsular contraction, 12 patients with grade I-II rippling and two patients (4.9%) with grade III rippling.Conclusions We present our experience of prepectoral polyurethane implant using complete ADM wrap. This is one of the few papers to report on the outcome of the prepectoral use of polyurethane in immediate implant-based breast reconstruction. Our early observational series show satisfactory outcome and long-term results are warranted by a large multicenter study.