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Objective Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery.Method The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients.Results There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups.Conclusion Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.

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The American Burn Association, Children's Burn Foundation, and Christian Medical College in Vellore, India have partnered together to improve pediatric burn care in Southern India. We report the demographics and outcomes of burns in this center, and create a benchmark to measure the effect of the partnership. A comparison to the National Burn Repository is made to allow for generalization and assessment to other burn centers, and to control for known confounders such as burn size, age, and mechanism. Charts from the pediatric burn center in Vellore, India were retrospectively reviewed and compared with data in the American Burn Association National Burn Registry (NBR) for patients younger than 16 years. One hundred nineteen pediatric patients with burns were admitted from January 2004 through April 2007. Average age was 3.8 years; average total body surface area burn was 24%: 64% scald, 30% flame, 6% electric. Annual death rate was 10%, with average fatal total body surface area burn was 40%. Average lengths of stay for survivors was 15 days. Delay of presentation was common (45% of all patients). Thirty-five of 119 patients received operations (29%). Flame burn patients were older (6.1 years vs 2.6 years), larger (30 vs 21%), had a higher fatality rate (19.4 vs 7.7%), and more of them were female (55 vs 47%) compared with scald burn patients. Electric burn patients were oldest (8.3 years) and all male. When compared with data in the NBR, average burn size was larger in Vellore (24 vs 9%). The mortality rate was higher in Vellore (10.1 vs 0.5%). The average mortal burn size in Vellore was smaller (40 vs 51%). Electric burns were more common in Vellore (6.0 vs 1.6%). Contact burns were almost nonexistent in Vellore (0.9 vs 13.1%). The differences in pediatric burn care from developing health care systems to burn centers in the US are manifold. Nonpresentation of smaller cases, and incomplete data in the NBR explain many of the differences. However, burns at this center in Vellore, India were larger, and occurred to younger patients than burns that reported in the NBR. Individualized assessment of care systems are needed when implementing development plans.

Foreign medical service trips, though worthy, raise questions about efficacy, durability, and cultural sensitivity. A structured intervention by a multidisciplinary team can lead to sustained and integrated changes in the delivery of burn care. The American Burn Association, Children's Burn Foundation, and other donors have sponsored four interventions with the Pediatric Burn Center at Christian Medical Center in Vellore, India. Using qualitative research methods, we report our interventions and changes in burn care in Vellore. Using a multifaceted intervention over 2 years, there are skilled and practiced changes in burn care in Vellore, India. These changes involved changes in medical care, nursing care, wound care, operative timing, patient activity, and rehabilitation. Protocols and student and staff education tools have been developed and implemented. Major changes in burn care were observed by the visiting burn team. These skills are practiced and routinely used. The Vellore burn team reports an improvement in nursing satisfaction, patient tolerance, cleanliness, decreased antibiotic use, earlier excision and grafting, and more efficient care. Educational partnerships to improve burn care can induce durable changes, regardless of local language, culture, resources, technology, and skill.

Introduction:Minimally invasive cardiac surgery (MICS) has been gaining popularity over conventional sternotomy due to reduced invasiveness. However, in redo cardiac surgery when the risks are higher due to adhesions, few studies compare long-term outcomes.Objective:We aim to compare the perioperative and long-term mortality and stroke/TIA rate in patients undergoing median sternotomy and right thoracotomy for redo cardiac surgery. Secondary outcomes were post-operative and total hospital stay, blood products used, return to theatre and new renal replacement therapy (RRT).Methods:We retrospectively analysed a cohort of 127 sternotomy patients and 29 right thoracotomy patients for redo cardiac surgery between 2010-2020. All patients underwent valve repair or replacement. Patients requiring concomitant cardiac procedures were included.Results:In-hospital and long-term follow-up were 100% and 98.1% complete and a maximum of 10.4 years. There were 52 deaths (33.3%) within the follow-up period. Perioperative mortality was 16.5% in sternotomy versus 3.45% in MICS, although this difference was insignificant after adjustment for logistic EuroSCORE (HR 0.38, [0.05-2.79]). In multivariate analysis, long-term mortality was significantly lower in MICS (HR 0.30 [0.10-0.85]). Adjusted Kaplan-Meier curves revealed lower long-term mortality in the MICS group (p<0.0001). Differences in stroke/TIA rates were insignificant (odds ratio 3.23 [0.85-12.8]). There were significantly less RBC (p=0.0001) and total blood products (p=0.0032) used in the MICS group. All 12 patients who returned to theatre for bleeding complications were in the sternotomy group. Although mean post-operative and total hospital stay and new RRT were lower in the MICS group, these differences were insignificant.Conclusion:MICS for redo cardiac surgery is a safe and effective alternative to median sternotomy without compromising both short-term and long-term clinical outcomes.

The paper describes a tool to assess student learning, evaluate academic performance of students and aid students in career initiation and enhancement through the use of the Performance Evaluation Portfolio Program (PEPP). "What have graduates learned?" is a key question in the new AACSB accreditation standards. This paper will show how one university documents student learning and provides students with a career marketing edge through an innovative web-based portfolio program. The assignments in PEPP showcase student competencies, document learning outcomes across the curriculum, and provide graduating seniors with a personal marketing tool. The paper will discuss how the program was implemented, its benefits, and the lessons learned. [ABSTRACT FROM AUTHOR]

The preferred treatment of displaced supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Cross-wiring techniques are biomechanically superior to parallel lateral wiring techniques. The purpose of this study was to review the authors’ experience with a novel cross-wiring technique performed entirely from the lateral side. Twenty children with supracondylar fractures who were manipulated and wired using a lateral cross-wiring technique were reviewed. Patient demographics, mechanism of injury, fracture classification, and associated neurovascular injuries were noted. All fractures were reduced, cross-wired from the lateral side, and rested in an above-elbow slab. Wires were removed at 4 weeks. Range of motion and carrying angle were measured at follow-up. Lateral cross-wiring of supracondylar fractures represents a real option in the treatment of these injuries, offering the biomechanical advantages of traditional cross-wiring without the risk of ulnar nerve injury.

Sport marketing is a relatively young professional and academic field. Young in that it only recently has received the attention befitting an aspect of the overall marketing field that holds the number of opportunities to create significant relationships between consumers and corporations. Of the four major leagues of sport in North America, the ones that place an emphasis on marketing themselves well are easily separated from those that have not. The National Basketball Association (NBA) has experienced 12 years of growth in large part due to the presence of gifted marketers in high ranking positions (Lefton, 1996). The National Hockey League (NHL) began its own growth spurt after naming a former NBA executive as its commissioner (Cohen, 1994). These two leagues have taken similar routes, and are both arriving at success.That's more than can be said for their brethren, Major League Baseball (MLB) and the National Football League (NFL). These two leagues have found their own paths to lackluster fan interest, sagging merchandise sales, and poor overall images. The retirement of one sport's commissioner and the death of the other's have altered the marketing leadership for each league. Combined with labor stoppages and an increase in franchise mobility, the lack of a creative marketing emphasis in each league's strategic planning has caused significant difficulties for the organizations and their members.This paper discusses the marketing efforts of each league and provides recommendations to improve the reputation, value, and salability of each league in the consumer's mind. These recommendations are based on a literature review of selected trade magazines and journal articles and pertinent information derived from the marketing discipline.

We present our experience of six children with bilateral single-system ureteral ectopia and two children with unilateral single ectopic ureters and contralateral renal agenesis. The wide spectrum of malformations indicates an embryological insult in addition to anomalous ureteric buds. There appears to be an element of antenatal ureteral obstruction affecting some renal units and sparing ectopic contralateral units. Ureteric reimplantation into the embryologically diverted bladder, without additional bladder neck surgery or augmentation, resulted in a satisfactory outcome in the majority of cases. Reimplantation techniques may require modification when the bladder is very small, and a simple ureteric nipple has proven effective in preventing reflux.

Summary: A method for isolation of mouse liver cells by a two-step perfusion with calcium and magnesium-free Hanks' salt solution followed by a medium containing collagenase is described. Several variations of the commonly used procedure for rat liver cell isolation were quantitatively compared with respect to cell yield and viability. The optimal isolation technique involved perfusion through the hepatic portal vein and routinely produced an average of 2.3106 viable liver cells/g body weight. Optimal perfusate collagenase concentration was found to be 100 U of enzyme activity per milliliter of perfusate. Light and electron microscopic evaluation of liver morphology after several steps of the isolation showed distinct morphologic changes in hepatocytes and other liver cells during perfusion. After perfusion with Hanks' calcium-and magnesium-free solution, many hepatocytes exhibited early reversible cell injury. These changes included vesiculation and slight swelling of the endoplasmic reticulum as well as mitochondrial matrix condensation. Subsequent to perfusion with collagenase, the majority of hepatocytes appeared connected to one another only by tight junctional complexes at the bile canaliculi. Multiple evaginations were see on the outer membrane resembling microvilli and probably represented the remains of cell-to-cell interdigitations between hepatocytes and sinusoidal lining cells from the space of Disse. The cytoplasmic injury seen after Hanks' perfusion was reversed after collagenase perfusion. After mechanical dispersion, isolated mouse hepatocytes were spherical in shape and existed as individual cells; many (80 to 85%) were binucleated under phase contrast light microscopy. By electron microscopy, cells appeared morphologically similar in cytoplasmic constitution to that seen in intact nonaltered liver cells.

The estuarine modifications of zinc during its transport through the tropical Cochin estuary was evaluated by speciation studies. The fractions of zinc reported include Chelex-100 labile and organically bound metal in the aqueous phase and exchangeable and total metal in the particulate phase. The behaviour of each of the above fraction in relation to the environmental factors such as salinity, suspended solids load and DOC is presented. The behavioural profile indicates the removal of all the fractions in the saline region of this tropical estuary. The mass balance indicated accumulation of zinc in the estuarine regions.

New nitrate- and thiocyanate- containing complexes of Thorium (IV) and Dioxouranium (VI) with certain antipyrine ligands have been synthesized and characterized by elemental analysis, molar conductance, infrared spectra and thermal analysis.

We present two cases of aplasia cutis congenita (ACC). The scalp alone was involved in the first baby, who died from massive sagittal sinus hemorrhage. The second neonate presented with circumferential constrictive trunk ulcers and healed scars on the thighs, axillae, and temples in addition to the scalp lesion. This baby was successfully treated with local flap cover of the scalp and trunk ulcers. A biopsy from the edge of the scalp ulcer revealed a dermoid cyst. This provides new evidence in support of the amniotic band theory of origin of ACC.

The article presents the authors view about the biotech companies including the operation of the biotech companies in volatile market, the dropped of clinical programs by Ignyta and the importance of proper management in business assets.

An 11-year-old girl presented with dribbling of urine, mild clitoral hypertrophy, and an accessory subphalic urethra. The main urethra opened into a urine-storing vagina. A simple Y-V vaginoplasty was curative by allowing free egress of urine from the vagina.