Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery. METHODS: The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality. RESULTS: The median postoperative nadir platelet count was 121 × 10/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 10/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001). CONCLUSION: The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.

Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis.

BACKGROUND: Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS: A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS: The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS: Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.

Two Cases of Late Shone Syndrome With Pulmonary Hypertension: Heart-Lung Transplant or Valve Surgery?

Two cases of Shone syndrome with severe mitral and aortic valve problems and pulmonary hypertension were referred for heart-lung transplantation. Severely elevated pulmonary vascular resistance (PVR) was confirmed as was severe periprosthetic mitral and aortic regurgitation. Based on the severity of the valve lesions in both patients, surgery was decided upon and undertaken. Both experienced early pulmonary hypertensive crises, one more than the other, that gradually subsided, followed by excellent recovery and reversal of pulmonary hypertension and PVR. These cases illustrate Braunwald's concept that pulmonary hypertension secondary to left-sided valve disease is reversible.

VegeDog: Formalism, vegetarian dogs, and partonomies in transition

The pragmatics of 'vegetarian' and 'carnivorous' exhibits an asymmetry that we put in evidence by analyzing a newspaper report about vegetarian dog-owners imposing a vegetarian diet on their pets. More fundamental is the problem of partonomy versus containment, for which we attempt a naive but formal analysis applied to ingestion and the food chain, an issue we derive from the same text analyzed. Our formal tools belong in commonsense modelling, a domain of artificial intelligence related to extra-linguistic knowledge and pragmatics. We first provide an interpretation of events analyzed, and express it graphically in a semantic-network related representation, and propose an alternative that we express in terms of a modal logic, avoiding the full representational power of Hayes's "ontology for liquids".

On treating the symptoms and not the cause: reflections on the Dangerous Dogs Act

The experience of saving a dog that later turned out to be a Pit Bull and therefore banned under the Dangerous Dogs Act 1991, made me investigate the Act and its implications. The Act is not built on evidence and by compiling results from different studies on dog bites and breed‐specific legislation in different countries the conclusion is that there is not much empirical support for breed bans either. ‘Dangerous breeds’ do not bite more frequently than German Shepherds and directing legislation towards certain breeds deemed as ‘dangerous’ cannot therefore be seen as justified. The strength of the label ‘dangerous dog’ seems to rule out policies that follow the facts and there is more treating of symptoms than causes. [From the Author]

When deterrence works - and when it doesn't: a comparison of Sweden's prostitution law and UK's Dangerous Dogs Act

Many pieces of legislation have been implemented with the anticipation - or justification - that they will have a deterrent effect. Deterrence was clearly argued in the debate preceding the Swedish prostitution law prohibiting the purchase of sexual services, but less so regarding the Dangerous Dogs Act, which was a very rapid response to a particular moral panic. As it turned out, the Swedish law has had a deterrent effect on street prostitution in that 'respectable' buyers were deterred. It will be argued that it is this very 'respectability' that makes deterrence work in this case. Regarding the Dangerous Dogs Act, the owners of Pit Bulls and other banned breeds are not considered 'respectable' and the banning might have had the reversed effect - increasing the attraction of these dogs, rather than deterring the ownership. Apart from deterrence and its consequences, the rendering invisible of key actors - buyers and owners respectively - and the use of symbolic legislation to promote moral messages will also be considered. [From the Author]

Pathophysiology of feline hyperadrenocorticism clinical. Case presentation

Hyperadrenocorticism is a rare endocrine disease in the cat; it is characterized by elevated blood cortisol level that generates numerous clinical signs including hyperglycemia, polyuria, polydipsia, polyphagia and skin diseases. The average age of onset is around 10 years. This disease usually occurs link with other endocrine disorders such as diabetes mellitus.The disease can be produced by functional alteration of the pituitary gland or the adrenal. A case report, with differential diagnosis and review of the literature, is presented.