The Experts below are selected from a list of 349254 Experts worldwide ranked by ideXlab platform
Fraser D Rubens - One of the best experts on this subject based on the ideXlab platform.
-
assessment of the association of bilateral internal thoracic artery Skeletonization and sternal wound infection after coronary artery bypass grafting
The Annals of Thoracic Surgery, 2016Co-Authors: Fraser D Rubens, Li Chen, Michael BourkeAbstract:Background Skeletonization is a technique of bilateral internal thoracic artery (BITA) harvest that preserves sternal blood flow. We sought to identify the relationship of Skeletonization and sternal wound infection in a population undergoing BITA harvest. Methods Demographics and outcomes were recorded from patients undergoing coronary artery bypass graft surgery with BITA using either skeletonized (n = 531) or nonskeletonized (n = 970) techniques. The primary outcome was total infection. Propensity scores analysis as well as univariable and multivariable analysis was performed to determine the effect of Skeletonization in the total cohort and in each sex. Results Although patients undergoing skeletonized BITA had a lower body mass index, they were significantly older, with a higher proportion of women, diabetes mellitus, urgent or emergent surgery, renal failure, vascular and lung disease, and lower preoperative hemoglobin. There was a significant effect of Skeletonization in decreasing total infection incidence (odds ratio [OR] 0.606, 95% confidence interval [CI]: 0.383 to 0.959, p = 0.032). The effect of Skeletonization on total infection in men was more prominent (OR 0.466, 95% CI: 0.290 to 0.870), whereas there was no effect in women (OR 0.887, 95% CI: 0.441 to 1.786). Multivariable analysis confirmed that Skeletonization was protective (OR 0.606, 95% CI: 0.383 to 0.957, p = 0.032). Other factors associated included being female (OR 3.327, 95% CI: 2.080 to 5.322, p p = 0.001), peripheral vascular disease (OR 2.101, 95% CI: 1.247 to 3.539, p = 0.005), increased body mass index (OR 1.100, 95% CI: 1.054 to 1.149, p p = 0.013). Conclusions Skeletonization is associated with a significant protective effect with regard to sternal infection after coronary artery bypass graft surgery with BITA. Being female is a major risk factor for infection, and the risk is not modified significantly with a strategy of Skeletonization in women.
-
skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery a randomized double blind within patient comparison
Circulation, 2006Co-Authors: Munir Boodhwani, Howard J Nathan, Khanh B Lam, T G Mesana, M Ruel, Wanzhen Zeng, Frank W Sellke, Fraser D RubensAbstract:Background— Observational studies suggest that Skeletonization of the internal thoracic artery (ITA) can improve conduit flow and length and reduce deep sternal infections and postoperative pain. We performed a randomized, double-blind, within-patient comparison of skeletonized and nonskeletonized ITAs in patients undergoing coronary surgery. Methods and Results— Patients (n=48) undergoing bilateral ITA harvest were randomized to receive 1 skeletonized and 1 nonskeletonized ITA. Intraoperatively, ITA flow was assessed directly and with a Doppler flow probe before and after topical application of papaverine. ITA harvest time and conduit length were recorded. A blinded assessment of pain (visual analog scale) and dysesthesia (physical examination) was performed at discharge, at 2 weeks, and at a 3-month follow-up. Sternal perfusion was assessed with nuclear imaging (n=7). Skeletonization required longer ITA harvest times (27±1 versus 24±1 minutes; P=0.04). There was a trend toward increased ITA length in th...
-
the internal thoracic artery Skeletonization study a paired within patient comparison nct00265499
Trials, 2006Co-Authors: Munir Boodhwani, Howard J Nathan, Fraser D RubensAbstract:Background Traditional harvesting of the internal thoracic artery (ITA) for use as a conduit in coronary bypass surgery involves the dissection of a rim of tissue surrounding the artery on either side. Recent studies, primarily observational, have suggested that Skeletonization of the ITA can improve conduit flow, increase length, and reduce the risk of deep sternal infection in high risk patients. Furthermore, Skeletonization of the ITA can potentially preserve intercostal nerves and reduce post-operative pain and dysesthesias associated with ITA harvesting. In order to assess the effects of ITA Skeletonization, we report a prospective, randomized, within-patient study design that shares many features of a cross-over study.
-
The internal thoracic artery Skeletonization study: A paired, within-patient comparison [NCT00265499]
Trials, 2006Co-Authors: Munir Boodhwani, Howard J Nathan, Fraser D RubensAbstract:Background Traditional harvesting of the internal thoracic artery (ITA) for use as a conduit in coronary bypass surgery involves the dissection of a rim of tissue surrounding the artery on either side. Recent studies, primarily observational, have suggested that Skeletonization of the ITA can improve conduit flow, increase length, and reduce the risk of deep sternal infection in high risk patients. Furthermore, Skeletonization of the ITA can potentially preserve intercostal nerves and reduce post-operative pain and dysesthesias associated with ITA harvesting. In order to assess the effects of ITA Skeletonization, we report a prospective, randomized, within-patient study design that shares many features of a cross-over study. Methods Patients undergoing bilateral internal thoracic artery harvest will be randomized to having one side skeletonized and the other harvested in a non-skeletonized manner. Outcome measures include ITA flow and length measured intra-operatively, post-operative pain and dysesthesia, evaluated at discharge, four weeks, and three months post-operatively, and sternal perfusion assessed using single photon emission computed tomography. Harvest times as well as safety endpoints of ITA injury will be recorded. Discussion This study design, using within-patient comparisons and paired analyses, minimizes the variability of the outcome measures, which is seldom possible in the evaluation of surgical techniques, with minimal chance of carryover effects that can hamper the interpretation of traditional cross-over studies. This study will provide a valid evaluation of clinically relevant effects of internal thoracic artery Skeletonization in improving outcomes following coronary artery bypass surgery.
Thanos Athanasiou - One of the best experts on this subject based on the ideXlab platform.
-
effect of Skeletonization of the internal thoracic artery for coronary revascularization on the incidence of sternal wound infection
The Annals of Thoracic Surgery, 2010Co-Authors: Srdjan Saso, David R C James, Joshua A Vecht, Emaddin Kidher, John Kokotsakis, Vitali Malinovski, Ara Darzi, Jon R Anderson, Thanos AthanasiouAbstract:Use of the internal thoracic artery in coronary revascularization confers excellent benefit. We assessed the impact of Skeletonization on the incidence of postoperative sternal wound infection in patients undergoing coronary artery bypass grafting. We also investigated whether there is an advantage in using this technique when harvesting both internal thoracic arteries in high-risk groups, such as diabetic patients. Skeletonization was associated with beneficial reduction in the odds ratio of sternal wound infection (odds ratio, 0.41; 95% confidence interval, 0.26 to 0.64). This effect was more evident when analyzing diabetic patients undergoing bilateral internal thoracic artery grafting (odds ratio, 0.19; 95% confidence interval, 0.10 to 0.34).
Xin-qing Sheng - One of the best experts on this subject based on the ideXlab platform.
-
Thermoplasmonic Simulation of Metallic Nanoparticles with Hierarchical Skeletonization
2019 International Applied Computational Electromagnetics Society Symposium - China (ACES), 2019Co-Authors: Jun Chen, Da-miao Yu, Xin-qing ShengAbstract:Thermoplasmonics leads to enhanced heat generation due to the localized surface plasmon resonances. In this paper, hierarchical Skeletonization for differential equations (HSDE) is used to solve light absorption problems with metallic nanostructures. Numerical results show that HSDE is more efficient than MUltifrontal Massively Parallel Solver (MUMPS).
-
Wide Angular Sweeping of Dynamic Electromagnetic Responses From Large Targets by MPI Parallel Skeletonization
IEEE Transactions on Antennas and Propagation, 2018Co-Authors: Si-lu Huang, Xin-qing ShengAbstract:It has been revealed that the interpolative decomposition (ID) Skeletonization can greatly accelerate the wide angular sweeping, which involves repeatedly solving many/massive incidents. However, the peak memory usage required by Skeletonization may be a bottleneck of that algorithm. In this communication, a message passing interface parallel Skeletonization scheme is developed to alleviate the memory usage and to incorporate with the parallel multilevel fast multipole algorithm (MLFMA) for large targets, which are hundreds of wavelengths in size. The parallel scheme includes two ingredients. One is to feed into the ID, a size-reduced matrix to find skeleton right-hand sides. This matrix is produced upon skeleton RWGs instead of their original counterpart. The other is to integrate the parallel ID into the parallel MLFMA to alleviate the peak memory usage of Skeletonization on each participating process. Numerical experiments show that the peak memory usage for the Skeletonization can be less than 2 GB in each process for the target about 300 wavelengths in size.
-
Fast solution of linear systems with many right hand sides using MPI parallel Skeletonization
2017 IEEE International Symposium on Antennas and Propagation & USNC URSI National Radio Science Meeting, 2017Co-Authors: Si-lu Huang, Xin-qing ShengAbstract:It has been proved that the interpolative decomposition (ID) Skeletonization can greatly accelerate the simulation where many incidents have to be repeatedly solved. However, the peak memory usage for the Skeletonization may be a bottleneck. In this work, an MPI parallelization of the Skeletonization is developed to alleviate the difficulty. Numerical experiments have been conducted to demonstrate the performance of the proposed parallel scheme.
-
Skeletonization accelerated multilevel fast multipole algorithm for volume integral equation
2017 IEEE International Symposium on Antennas and Propagation & USNC URSI National Radio Science Meeting, 2017Co-Authors: Xin-qing ShengAbstract:The Skeletonization accelerated multilevel fast multipole algorithm (MLFMA) in terms of surface integral equation (SIE) is extended to the method of moments (MoM) solution of volume integral equation (VIE). Boxes at the finest MLFMA level are recursively divided into smaller ones and the associated rank-deficient submatrices are approximated by Skeletonization. Numerical experiments are conducted to study the performance of the proposed algorithm.
-
Fast direct solution of volume integral equations based on Skeletonization by method of moments
2016 IEEE International Conference on Computational Electromagnetics (ICCEM), 2016Co-Authors: Ming-ming Xu, Xin-qing ShengAbstract:The fast direct solver based on Skeletonization is extended to the method of moments (MoM) solution of volume integral equations (VIE). The impedance matrix is approximated by the hierarchical data sparse representation through Skeletonization. The inverse matrix is then implicitly computed. Numerical experiments are conducted to study the performance of the direct solver.
Michael Bourke - One of the best experts on this subject based on the ideXlab platform.
-
assessment of the association of bilateral internal thoracic artery Skeletonization and sternal wound infection after coronary artery bypass grafting
The Annals of Thoracic Surgery, 2016Co-Authors: Fraser D Rubens, Li Chen, Michael BourkeAbstract:Background Skeletonization is a technique of bilateral internal thoracic artery (BITA) harvest that preserves sternal blood flow. We sought to identify the relationship of Skeletonization and sternal wound infection in a population undergoing BITA harvest. Methods Demographics and outcomes were recorded from patients undergoing coronary artery bypass graft surgery with BITA using either skeletonized (n = 531) or nonskeletonized (n = 970) techniques. The primary outcome was total infection. Propensity scores analysis as well as univariable and multivariable analysis was performed to determine the effect of Skeletonization in the total cohort and in each sex. Results Although patients undergoing skeletonized BITA had a lower body mass index, they were significantly older, with a higher proportion of women, diabetes mellitus, urgent or emergent surgery, renal failure, vascular and lung disease, and lower preoperative hemoglobin. There was a significant effect of Skeletonization in decreasing total infection incidence (odds ratio [OR] 0.606, 95% confidence interval [CI]: 0.383 to 0.959, p = 0.032). The effect of Skeletonization on total infection in men was more prominent (OR 0.466, 95% CI: 0.290 to 0.870), whereas there was no effect in women (OR 0.887, 95% CI: 0.441 to 1.786). Multivariable analysis confirmed that Skeletonization was protective (OR 0.606, 95% CI: 0.383 to 0.957, p = 0.032). Other factors associated included being female (OR 3.327, 95% CI: 2.080 to 5.322, p p = 0.001), peripheral vascular disease (OR 2.101, 95% CI: 1.247 to 3.539, p = 0.005), increased body mass index (OR 1.100, 95% CI: 1.054 to 1.149, p p = 0.013). Conclusions Skeletonization is associated with a significant protective effect with regard to sternal infection after coronary artery bypass graft surgery with BITA. Being female is a major risk factor for infection, and the risk is not modified significantly with a strategy of Skeletonization in women.
Raymond A Meek - One of the best experts on this subject based on the ideXlab platform.
-
considerations in the Skeletonization technique of internal thoracic artery dissection
The Annals of Thoracic Surgery, 1992Co-Authors: James M Cunningham, Mohammad A Gharavi, Rostam Fardin, Raymond A MeekAbstract:Abstract Skeletonization of the internal thoracic artery during myocardial revascularization procedures may provide some degree of protection from sternal wound infection in diabetic, obese, or pulmonary compromised patients when both internal thoracic arteries are used as conduits. Prior descriptions of the technique fail to provide specific details and possible pitfalls of the dissection. A method of Skeletonization that has been used at the California Center for Cardiothoracic Surgery in more than 1,000 patients is presented in detail. Potential advantages and disadvantages are discussed.
