EVALUATING THE RELATIONSHIP BETWEEN CLINICAL ASSESSMENTS OF APPARENT HAMSTRING TIGHTNESS: A CORRELATIONAL ANALYSIS.

Background: Hamstring tightness is a common condition typically assessed via the active knee extension (AKE), passive straight leg raise (PSLR), V-sit and reach (VSR), and finger-floor-distance (FFD).

Purpose: The purpose of this study was to investigate the relationships between four common clinical tests of apparent hamstring tightness. A secondary purpose was to compare the differences in correlations between sub-groups based on positive test findings.

Changes in Hamstring Range of Motion After Neurodynamic Sciatic Sliders: A Critically Appraised Topic.

Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared with stretching on traditional measures of range of motion (ROM)? Summary of Key Findings: The authors of a well-designed study found that neurodynamic sliders were more effective than static stretching, while the authors of 2 less-well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders.

Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue.

Objectives: The study was conducted to evaluate, on the basis of a multicentre analysis, current results of elective open aortic arch surgery performed during the last decade.

Methods: Data of 1232 consecutive patients who underwent aortic arch repair with reimplantation of at least one supra-aortic artery between 2004 and 2013 were collected from 11 European cardiovascular centres, and retrospective statistical examination was performed using uni- and multi-variable analyses to identify predictors for 30-day mortality. Acute aortic dissections and arch surgeries not involving the supra-aortic arteries were not included.

A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting.

Background: Chlorhexidine gluconate (CHG) is often recommended for skin antisepsis; however, the most efficacious concentration is currently unclear. Our objective was to compare the efficacy of 70% isopropyl alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin preparation in patients undergoing coronary artery bypass grafting.

Short-term intravenous sodium nitrite infusion improves cardiac and pulmonary hemodynamics in heart failure patients.

Background: Nitrite exhibits hypoxia-dependent vasodilator properties, selectively dilating capacitance vessels in healthy subjects. Unlike organic nitrates, it seems not to be subject to the development of tolerance. Currently, therapeutic options for decompensated heart failure (HF) are limited.

Role of aldehyde dehydrogenase in hypoxic vasodilator effects of nitrite in rats and humans.

Background And Purpose: Hypoxic conditions favour the reduction of nitrite to nitric oxide (NO) to elicit vasodilatation, but the mechanism(s) responsible for bioconversion remains ill defined. In the present study, we assess the role of aldehyde dehydrogenase 2 (ALDH2) in nitrite bioactivation under normoxia and hypoxia in the rat and human vasculature.

Experimental Approach: The role of ALDH2 in vascular responses to nitrite was studied using rat thoracic aorta and gluteal subcutaneous fat resistance vessels from patients with heart failure (HF; 16 patients) in vitro and by measurement of changes in forearm blood flow (FBF) during intra-arterial nitrite infusion (21 patients) in vivo.

Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis.

Background: A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points.

Methods: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists.

One-stage repair in complex multisegmental thoracic aneurysmal disease: results of a multicentre study.

Objectives: Patients with thoracic aneurysmal disease involving the arch and the descending or thoracoabdominal aorta may require more than one surgical intervention. The results of one-stage repair using a hybrid stent-graft in the frozen elephant trunk manner are presented.

Methods: Between January 2005 and March 2012, 113 (age 67 ± 10 years) of 358 registered patients in the International E-Vita Open Registry were operated on for combined arch and descending and thoracoabdominal aortic aneurysm.

Measurement of extravascular lung water following human brain death: implications for lung donor assessment and transplantation.

Objectives: The measurement of extravascular lung water could aid the assessment and guide the management of potential lung donors following brain death. We therefore sought to validate a single indicator thermodilution extravascular lung water index (EVLWI-T) measurement using gravimetry and to assess the impact and clinical correlates of elevated EVLWI-T in potential lung donors and transplant recipients.

Methods: In a prospective study, we measured serial EVLWI-T and haemodynamic and oxygenation data in 60 potential lung donors.

Spontaneous aortic rupture early postpartum without trauma or connective tissue disorder.

Rupture of the thoracic aorta is a rare but recognized complication following pregnancy. The common causes of thoracic aortic rupture in the peripartum period are trauma, dissecting aneurysms and saccular aneurysms secondary to systemic connective tissue disease. We report a case of non-traumatic spontaneous aortic rupture in a patient without trauma or systemic connective tissue disease 1 day postpartum, which was successfully managed by surgical repair of the thoracic aorta.

The future of aortic surgery in Europe.

At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS).

A systematic review and meta-analysis of the cardioprotective effects of remote ischaemic preconditioning in open cardiac surgery.

Objective: To investigate the cardioprotective efficacy of remote ischaemic preconditioning (RIPC) in cardiac surgery.

Design: We have performed a systematic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify randomized controlled trials involving RIPC.

Setting: Randomized controlled trials of RIPC in open cardiac surgery patients.

Cardiac transplantation for spontaneous coronary artery dissection.

We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thrombolysis and coronary angioplasty failed to perfuse the myocardium. She was unsuitable for emergency coronary artery bypass grafting surgery due to the interval elapsed between the myocardial infarction, thrombolysis and large infracted myocardium. Ventricular-assisted device support for a bridge to recovery or transplantation is a widely accepted treatment modality; however, in this case, it was unadvisable due to the extent of the infarcted myocardium and the risk of suturing outflow ports into the infracted myocardium.

Acute aortic dissection type A.

Background: Acute aortic dissection type A (AADA) is a life-threatening vascular emergency. Clinical presentation ranges from pain related to the acute event, collapse due to aortic rupture or pericardial tamponade, or manifestations of organ or limb ischaemia. The purpose of this review was to clarify important clinical issues of AADA management, with a focus on diagnostic and therapeutic challenges.

Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis.

Aim: Randomised trials exploring remote ischaemic preconditioning (RIPC) in patients undergoing coronary artery bypass graft (CABG) surgery have yielded conflicting data regarding potential cardiovascular and renal protection, and are individually flawed by small sample size.

Methods: Three investigators independently searched the MEDLINE, EMBASE and Cochrane databases to identify randomised trials testing RIPC in patients undergoing CABG.

Results: Nine studies with 704 patients were included.

Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery.

Objectives: To determine the predictors of post-operative renal function following adult cardiac surgery, and to assess the influence of this on late survival.

Methods: Prospectively collected data were analysed on 8032 patients who underwent coronary artery bypass grafting, valve surgery or combined procedures from 1 January 1998 until 31 December 2008, who did not require preoperative renal replacement therapy. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula accounting for ethnicity pre-operatively, post-operatively on the fourth post-operative day, and the post-operative nadir based upon the peak post-operative creatinine within 30 days of surgery.

Chronic kidney disease after nonrenal solid organ transplantation: a histological assessment and utility of chronic allograft damage index scoring.

Background: It is proposed that chronic calcineurin inhibitor (CNI) nephrotoxicity has a central role in chronic kidney disease after nonrenal solid organ transplantation (NRSOT), although there are little data on renal histology in this setting. The aim of this study was to assess the histological features and renal outcomes of a cohort of patients with chronic kidney disease after NRSOT.

Methods: Renal biopsies of 62 NRSOT recipients were evaluated for histological diagnoses.

Management of the heartbeating brain-dead organ donor.

The main factor limiting organ donation is the availability of suitable donors and organs. Currently, most transplants follow multiple organ retrieval from heartbeating brain-dead organ donors. However, brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval.

Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection.

Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary.

The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience.

Background: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.

Methods: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry.

Endocrine changes in brain death and transplantation.

Following brain death (BD) many hormonal changes occur. These include an increase and then a fall in the levels of circulating catecholamines, reduced levels of anti-diuretic hormone and cortisol as well as alterations in the hypothalamic-pituitary thyroid axis consistent with the non-thyroidal illness syndrome. In an era when the numbers of potential recipients listed for transplantation are greater than the number of donors, with an increasing donor age, a detailed knowledge of the endocrine changes and pathophysiological consequences of these is essential to optimise the management of the brain-stem dead organ donor.