The Value and Limitations of Guidelines, Expert Consensus, and Registries on the Management of Patients with Thoracic Aortic Disease

Davide Pacini,Giacomo Murana,Alessandro Leone,Luca Di Marco,Antonio Pantaleo 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.6

Doctors are often faced with difficult decisions and uncertainty when patients need a certain treatment. They routinely rely on the scientific literature, in addition to their knowledge, experience, and patient preferences. Clinical practice guidelines are created with the intention of facilitating decision-making. They may offer concise instructions for the diagnosis, management (medical or surgical treatments), and prevention of specific diseases o r conditions. All information included in t he f inal v ersion a re the r esult of a s ystematic rev iew of scientific articles and an assessment of the benefits and costs of alternative care options. The final document attempts to meet the needs of most patients in most circumstances and clinicians, aware of these recommendations, should always make individualized treatment decisions. In this review, we attempted to define the intent and applicability of clinical practice guidelines, expert consensus documents, and registry studies, focusing on the management of patients with thoracic aortic disease.

Both/And: Reflections on Recent Anglo/Western Early Childhood Curriculum Statements

Alan Pence,Veronica Pacini-Ketchabaw 육아정책연구소 2010 International Journal of Child Care and Education Vol.4 No.2

This paper identifies innovative work on curriculum undertaken in New Zealand in the 1990s as inspirational for recently developed frameworks in Australia and parts of Canada. The paper argues that the form this incorporation has taken in Canada and Australia is, almost literally, an opening of ‘some space’—as the more established modernist and technical understandings have not been entirely transformed or removed, but rather joined by perspectives that emphasize the need for a more complex, reflective and contextually situated practitioner—creating a contemporary policy landscape of ‘both/and’. The paper describes and analyzes in detail the processes and dynamics of the ‘both/and’ landscape achieved in British Columbia, Canada.

Glucose Effectiveness from Short Insulin-Modified IVGTT and Its Application to the Study of Women with Previous Gestational Diabetes Mellitus

Micaela Morettini,Carlo Castriota,Christian Göbl,Alexandra Kautzky-Willer,Giovanni Pacini,Laura Burattini,Andrea Tura 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.2

Background: This study aimed to design a simple surrogate marker (i.e., predictor) of the minimal model glucose effectiveness (SG), namely calculated SG (CSG), from a short insulin-modified intravenous glucose tolerance test (IM-IVGTT), and then to apply it to study women with previous gestational diabetes mellitus (pGDM). Methods: CSG was designed using the stepwise model selection approach on a population of subjects (n=181) ranging from normal tolerance to type 2 diabetes mellitus (T2DM). CSG was then tested on a population of women with pGDM (n=57). Each subject underwent a 3-hour IM-IVGTT; women with pGDM were observed early postpartum and after a follow-up period of up to 7 years and classified as progressors (PROG) or non-progressors (NONPROG) to T2DM. The minimal model analysis provided a reference SG. Results: CSG was described as CSG=1.06×10–2+5.71×10–2×KG/Gpeak, KG being the mean slope (absolute value) of loge glucose in 10–25- and 25–50-minute intervals, and Gpeak being the maximum of the glucose curve. Good agreement between CSG and SG in the general population and in the pGDM group, both at baseline and follow-up (even in PROG and NONPROG subgroups), was shown by the Bland-Altman plots (<5% observations outside limits of agreement), and by the test for equivalence (equivalence margin not higher than one standard deviation). At baseline, the PROG subgroup showed significantly lower SG and CSG values compared to the NONPROG subgroup (P<0.03). Conclusion: CSG is a valid SG predictor. In the pGDM group, glucose effectiveness appeared to be impaired in women progressing to T2DM.

Transcatheter Mitral Valve Implantation in Open Heart Surgery: An Off-Label Technique

Jacopo Alfonsi,Giacomo Murana,Anna Corsini,Carlo Savini,Roberto Di Bartolomeo,Davide Pacini 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.6

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. T he a ortic valve was replaced u sing a s tentless v alve p rosthesis (LivaNova S OLO; L ivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience

Luca Di Marco,Antonio Pantaleo,Alessandro Leone,Giacomo Murana,Roberto Di Bartolomeo,Davide Pacini 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.1

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The FET technique is also indicated in acute type A a ortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the FET technique for the treatment of complex aortic disease of the thoracic aorta.

Use of Denaturing High-Performance Liquid Chromatography (DHPLC) to Characterize the Bacterial and Fungal Airway Microbiota of Cystic Fibrosis Patients

Jérôme Mounier,Geneviève Héry-Arnaud,Audrey Gouëllo,Marlène Keravec,Solène Le Gal,Grégory Pacini,Stella Debaets,Gilles Nevez,Gilles Rault,Georges Barbier 한국미생물학회 2014 The journal of microbiology Vol.52 No.4

The aim of this study was to evaluate the use of denaturinghigh-performance liquid chromatography (DHPLC) to characterizecystic fibrosis (CF) airway microbiota includingboth bacteria and fungi. DHPLC conditions were first optimizedusing a mixture of V6, V7 and V8 region 16S rRNAgene PCR amplicons from 18 bacterial species commonlyfound in CF patients. Then, the microbial diversity of 4 sputumsamples from 4 CF patients was analyzed using culturalmethods, cloning/sequencing (for bacteria only) and DHPLCpeak fraction collection/sequencing. DHPLC analysis allowedidentifying more bacterial and fungal species than the classicalculture methods, including well-recognized pathogenssuch as Pseudomonas aeruginosa. Even if a lower number ofbacterial Operational Taxonomic Units (OTUs) was identifiedby DHPLC, it allowed to find OTUs unidentified bycloning/sequencing. The combination of both techniquespermitted to correlate the majority of DHPLC peaks to definedOTUs. Finally, although Aspergillus fumigatus detectionusing DHPLC can still be improved, this techniqueclearly allowed to identify a higher number of fungal speciesversus classical culture-based methods. To conclude, DHPLCprovided meaningful additional data concerning pathogenicbacteria and fungi as well as fastidious microorganisms presentwithin the CF respiratory tract. DHPLC can be consideredas a complementary technique to culture-dependentanalyses in routine microbiological laboratories.