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Bayesian Pseudoinverse Pupils: Coming from Doubt for you to Deterministic Learning.
Patients receiving cardiac surgery are susceptible to anemia. Low hemoglobin concentration is a risk factor for composite adverse events and mortality after cardiac surgery. Here we investigated the association of postoperative nadir hemoglobin with adverse outcomes in patients undergoing on-pump cardiac surgery.

Adult patients in two medical centers were retrospectively analyzed. Primary outcome was postoperative composite adverse event. Secondary outcome was all-cause mortality in hospital.

Of the 8206 patients analyzed, 1628 (19.8%) experienced composite adverse events after surgery and 109 (1.3%) died. Patients receiving on-pump cardiac surgery with nadir hemoglobin of 9.0-9.9 g/L showed low incidence of composite adverse events (175 of 1423; 12.3%) and mortality (5 of 1423; 0.4%). Compared with nadir hemoglobin at 9.0-9.9 g/dL, the relative risk (RR) of composite adverse events increased stepwise as nadir hemoglobin fell below 9.0 g/dL adjusted RR was 1.44 (95%Confidence interval (CI) 1.14-1.83) for 8.5-8.9 g/dL, 1.56 (95%CI 1.23-1.99) for 8.0-8.4 g/dL, 1.66 (95%CI, 1.31-2.11) for 7.5-7.9 g/dL, 2.22 (95%CI, 1.75-2.83) for 7.0-7.4 g/dL, and 4.00 (95%CI, 3.18-5.04) for < 7 .0 g/dL. Furthermore, the riskof mortality was significantly higher when nadir hemoglobin was below 7.0 g/dL than when it was 9.0-9.9 g/dL (RR 5.36; 95%CI, 2.20-16.12).

Compared to the risks when nadir hemoglobin is 9.0-9.9 g/dL, the risk of composite adverse events increases when postoperative nadir hemoglobin is below 9.0 g/dL, while risk of mortality increases when nadir hemoglobin is below 7.0 g/dL.
Compared to the risks when nadir hemoglobin is 9.0-9.9 g/dL, the risk of composite adverse events increases when postoperative nadir hemoglobin is below 9.0 g/dL, while risk of mortality increases when nadir hemoglobin is below 7.0 g/dL.
Treatment selection for patients with esophageal adenocarcinoma (EA) is predicated on clinical staging information, which is inaccurate in 20%-30% of cases and should impact the delivery of guideline-concordant treatment. We aimed to evaluate the association between staging concordance at the patient- and hospital-level with the delivery of guideline-concordant treatment among EA patients.

National cohort study of resected EA patients in the National Cancer Data Base (2006-2015) treated either with upfront resection or neoadjuvant therapy (NAT) followed by surgery. Patient- and hospital-level clinical and pathological staging concordance and deviations from treatment guidelines were ascertained. For NAT patients, staging concordance was predicted through Bayesian analysis. Reliability adjustment was used when evaluating hospital-level concordance.

Among 9,393 EA patients treated at 927 hospitals, 41% had upfront surgery. Among upfront surgery patients, staging concordance was 85.1% for T1N0 and 86.9% for T3-T4N+ disease, but <50% for all others. Among patients treated with NAT, treatment downstaging was observed in 33.9%. Deviations from treatment guidelines were identified in 38.5% of upfront surgery patients and 3.3% in NAT patients. The proportion of concordantly staged patients ranged from 60.1% to 87.9%, and deviations from treatment guidelines were observed among 14.9% to 22.7% of the patients. Patient staging concordance increased, and deviations from guidelines decreased as hospital-level concordance increased (trend test, p values < 0.001 for all).

Deviations from treatment guidelines in EA patients appear to be a function of inaccurate clinical staging information, which should be a new focus for quality improvement efforts.
Deviations from treatment guidelines in EA patients appear to be a function of inaccurate clinical staging information, which should be a new focus for quality improvement efforts.
Sex is suggested to influence outcomes after coronary artery bypass grafting (CABG) although evidence on long-term mortality is controversial and cardiovascular outcome data is lacking. We studied sex differences in outcomes after isolated CABG.

Consecutive patients with first-time isolated CABG for stable coronary artery disease between 2004-2014 in Finland were retrospectively recognized from national registry (n=14681, 21% women). Propensity scoring and inverse probability weighting were used to adjust for baseline features. Median follow-up was 10.0 (max 14.6) years.

Cumulative major adverse cardiovascular event (MACE; myocardial infarction, stroke, or cardiovascular death) rate was 44.5% in men and 49.9% in women during the follow-up (Hazard ratio [HR] 0.98; p=0.633). All-cause mortality was 48.5 % in men vs. 46.0% in women (HR 1.20; CI 1.11-1.30; p<0.0001) and cardiovascular mortality 29.5% vs. ML385 molecular weight 31.3% (p=0.625). Stroke rate was comparable between men and women (19.4% vs. 23.6%; p=0.625). Myocardering sex as a risk factor for CABG.Sinus of Valsalva aneurysm rupture is a potentially fatal condition that requires urgent surgical intervention. We report a case of right sinus of Valsalva aneurysm rupture into the right atrium, in a patient with a monocuspid aortic valve successfully managed with femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after pulseless electrical activity (PEA) cardiac arrest to facilitate complete surgical repair. The patient made a full recovery and was discharged home with no neurological deficit and had no limitations at one-year follow-up. This case highlights the utility of VA-ECMO in facilitating successful surgical repair when patients present in extremis.
The use of the left internal thoracic artery (LITA) is a golden standard in coronary artery bypass grafting (CABG). Multi-arterial grafting for CABG is being increasingly emphasized for CABG. This study aimed to solve the utility of the right ITA (RITA) for multiple CABG as "free" RITA and described new evidence.

One hundred sixty-three patients received solo CABG with bilateral ITAs between 2005 and 2018. The RITA was used as in situ RITA (Group-A, n=62) and or the composite graft created and saphenous vein graft (SVG) (Group-B, n=101). The patency rate and graft size of the composite 'free' RITA and SVG were examined by coronary computed tomographic angiography (CTA).

The average number of distal anastomoses per patient was 3.4±1.0 in Group-A, and 4.2±1.1 in Group-B (P<0.001). The sequential grafting with free RITA was in 86 patients. The patency rate of both LITA and RITA was similar in both groups. In Group-B, 40 patients received late CTA at a mean of 46 months (17-175 months). The late patency rate was 95.
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