Objective: The Cor-Knot automated fastener has been used to eliminate the need for manual knot-tying in cardiac valve surgery for over a decade. We review the current literature pertaining to Cor-Knot and discuss its benefits and shortcomings with respect to cardiac valve surgery. Methods: A comprehensive literature search was conducted to identify articles discussing the use of automated fasteners and manually tied knots in the setting of cardiac valve surgery. The search terms used were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener", "automated fastener", "aortic valve", "mitral valve", "minimally invasive", and "titanium". These terms were used as keywords and, in combination, as MeSH terms to maximize the output of literature searches. Twenty-four relevant articles were identified and reviewed. Results: Current literature provides evidence to support the role of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing total operation times as compared with manual knot-tying. However, studies to date fail to provide evidence for the translation of these intraoperative advantages into improved patient outcomes. Moreover, Cor-Knot is associated with a significant financial burden. Conclusion: A plethora of evidence exists to support the intraoperative advantages provided by Cor-Knot. However, the literature is yet to support its role in facilitating superior clinical outcomes as compared with manual knot tying. Larger high-quality trials and studies are required to provide evidence supporting the ongoing use of Cor-Knot in valve surgery.
High Intensity Focused Ultrasound (HIFU) capably bridges the disciplines of surgery, oncology and biomedical engineering science. It provides the precision associated with a surgical tool whilst remaining a truly non-invasive technique. Oxford has been a centre for both clinical and preclinical research in HIFU over the last twenty years. Research into this technology in the UK has a longer history, with much of the early research being carried out by Professor Gail ter Haar and her team at the Institute of Cancer Research at Sutton in Surrey. A broad range of potential applications have been explored extending from tissue ablation to novel drug delivery. This review presents Oxford's clinical studies and applications for the development of this non-invasive therapy. This includes treatment of solid abdominal tumours comprising those of the liver, kidney, uterus, pancreas, pelvis and prostate. It also briefly introduces preclinical and translational works that are currently being undertaken at the Institute of Biomedical Engineering, University of Oxford. The safety, wide tolerability and effectiveness of this technology is comprehensively demonstrated across these studies. These results can facilitate the incorporation of HIFU as a key clinical management strategy.
Background Potential conflicts of interest (CoI) are common in medical research, necessitating the use of CoI declarations. There is currently no consensus document or external authority guiding CoI declarations in conference settings, resulting in declarations of variable quality and utility. Methods We explored four CoI declaration parameters (sufficient slide display time; the presence of any verbal explanation pertaining to relevant CoI; the use of an adequate font size; and whether the nature and relevance of the CoI was described). Parameters were graded from one to three points, with the sum of parameters providing an overall declaration quality out of 12. We then applied this scoring system to recordings of presentations from the British Cardiovascular Society (BCS) annual conference 2018 which were available online. Results Sixty-nine presentations were suitable for inclusion, of which 47 (68%) contained a CoI statement. Thirty-six of the 47 (77%) presentations declared that they had no CoI. In the remaining 11 (23%) with reported CoI, the median time spent displaying CoI was 1 second (interquartile range (IQR) 0.7-3.3). The median quality score for presentations was 7 (IQR 6-10). Conclusion This study demonstrates utility in considering aspects of CoI declarations at conferences to improve transparency.
Funding Acknowledgements Type of funding sources: None. Background A significant gender bias has been identified in cardiology. Industry funding may be important developing electrophysiology (EP) and devices research. Such funding leads to potential conflicts of interest (COI) which must be disclosed on research presentations. There is limited evidence whether the gender bias in cardiology extends to industry funding of research. Purpose To assess whether COI disclosures in EP and devices presentations at the ESC Annual Congress differ between men and women. Methods Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, it was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Presentations with multiple speakers were also excluded. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively. Results Of 1,153 presentations assessed, 999 were suitable for inclusion. Women made up 22% (n = 221) of presenters. There was no difference in whether COI declaration slides were missing between women (5.9%, n = 13) and men (7.6%, n = 56), p = 0.38. In those with COI disclosure slides (n = 927), women declared significantly lower median number of COIs (0, IQR 0-3) compared with men (2, IQR 0-8), p < 0.0001. In contrast, women spent a greater time-per-word on their COI disclosure slides (250ms, IQR 125-375ms) compared with men (200ms, IQR 118-333ms), p < 0.0001. Conclusions Women made up a minority of presenters in EP/devices talks at the ESC annual congress. Women were less likely to have COIs which may suggest that they are less likely to receive industry funding. Despite this, women spent a greater amount of time-per-word on their COI slides. The lower number of declared COIs in women highlights another potential area of gender bias in cardiology that needs further investigation so that it can be addressed.
Funding Acknowledgements Type of funding sources: None. Background Interaction with industry is often required for the development of electrophysiology (EP) and devices research. Findings from industry-funded research are often presented at sponsored sessions during international conferences. However, industry interactions produce potential conflict of interests (COIs). Such COIs must be disclosed appropriately when presenting research findings to allow viewers to interpret the results correctly. This is particularly true during sponsored sessions. Purpose To assess whether session sponsorship affects the presentation of potential COIs in EP and devices presentations. Methods Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Sponsorship information was gathered from presentation meta-data. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively. Results Of 1,153 presentations assessed, 1,017 were suitable for inclusion. Of these 14% (n = 142) were sponsored sessions. COI disclosure slides were more likely to be missing in sponsored sessions (13.4%, n = 19) compared with non-sponsored sessions (6.2%, n = 54), p = 0.002. In those with COI disclosure slides, sponsored presentations contained a greater median number of COIs (12, IQR 6-19) compared with non-sponsored sessions (1, IQR 0-5), p < 0.0001. Conversely, the time-per-word spent on COI disclosures was approximately 50% lower in sponsored sessions (125ms, IQR 76-217ms) compared with non-sponsored sessions (250ms, IQR 125-375ms), p < 0.0001. Furthermore, presenters at sponsored sessions were much less likely than those at non-sponsored sessions to provide sufficient verbal details of their conflicts (0% vs 8.5% respectively, p = 0.0008). These findings were not materially altered when limited to only those presentations with COIs. Conclusions Sponsored sessions make up about one seventh of all EP/devices presentations at the ESC annual congress. Presenters at sponsored sessions were less likely to present a COI disclosure slide. Sponsored presentations had a higher number or of potential COIs, yet they were displayed for a far shorter time. This suggests that sponsored sessions have a higher risk of potential bias which viewers are not provided sufficient opportunity to assess.
Aims Industry collaboration with arrhythmia and devices research is common. However, this results in conflicts of interest (CoI) for researchers that should be disclosed. This study aimed to examine the quality of CoI disclosures in arrhythmia and devices presentations. Methods Recorded presentations from the Arrhythmia & Devices section of the ESC Annual Congress 2016–2020 were assessed. The number of words, conflicts, and time displayed was documented for CoI declarations. Meta-data including sponsorship by an industry partner, presenter sex, and institution were obtained. Results Of 1153 presentations assessed, 999 were suitable for inclusion. CoI statements were missing from 7.2% of presentations, and 58% reported ≥1 conflict. Those with conflicts spent less time-per-word on their disclosures (median 150 ms, interquartile range [IQR] 83–273 ms) compared with those without conflicts (median 250 ms, IQR 125–375 ms). One-in-eight presentations were sponsored (12.8%, n = 128). CoI statements were more likely to be missing in sponsored presentations (14.8%, n = 19) compared with non-sponsored presentations (6.1%, n = 53), P = 0.0003. Sponsored presentations contained a greater median number of CoIs (10, IQR 6–18) compared with non-sponsored sessions (1, IQR 0–5), P < 0.0001. Time-per-word spent on COI disclosures was 50% lower in sponsored sessions (125 ms, IQR 75–231 ms) compared with non-sponsored sessions (250 ms, IQR 125–375 ms), P < 0.0001. Conclusion The majority of those presenting arrhythmia and devices research have CoIs to declare. Declarations were often missing or displayed for short periods of time. Presenters in sponsored sessions, while being more conflicted, had a lower standard of declaration suggesting a higher risk of potential bias which viewers had insufficient opportunity to assess.
diseased coronary arteries (>50% stenosis) was used to assess the extent of CAD. Results HuR mRNA expression was significantly increased in patients with CAD (both stable and AMI) compared to controls (p=0.039). Subgroup analysis revealed that STEMI patients (n=107) had increased levels of HuR expression compared to NSTEMI (n=49, p=0.03). Among patients with stable CAD (n=133), high HuR expression was independently associated with the number of diseased coronary arteries (OR=1.35 for 1-SD increase in HuR, 95% CI 1.07-1.72, p=0.012), as well as with reduced ejection fraction (EF<45%, OR=1.32 per 1-SD increase, 95% CI 1.05-1.85, p=0.024). Among individuals without CVD, high HuR was associated with lower HDL levels (adjusted beta=-5.2 mg/dl for highest versus lowest quartile, p=0.03) and higher diastolic blood pressure (adjusted beta=3.6 mmHg, p=0.007), while, after adjustment for traditional cardiovascular risk factors, HuR levels in individuals without CVD were independently associated with increased IMT in the common carotid artery (mean increase 6.2% for highest versus lowest quartile, p=0.019). Conclusion HuR expression is associated with early subclinical arterial disease in individuals without clinically overt CVD and with the presence and severity of cardiac and vascular dysfunction in patients with clinically overt CAD. These findings imply a clinical role of the HuR pathway in cardiovascular disease and warrant further investigation.Abstract 115 Figure 2 Scoring parameters for presentations with potential conflicts of interest (n=12). a) All presentations with potential conflicts spent an adequate amount of time per declaration on their declaration slide (median=1.0s, IQR 0.8-3.0s). b) Five presentations (41%) with a potential conflict declared this with a font size <90% of the default BCS COI declaration font size. c) Five (41%) presentations with a potential conflict did not offer a verbal explanation of their conflict. Abstracts
This case report illustrates the complexity and severity of acute aortic dissection. This condition has one of the highest mortality rates of any cardiovascular emergency and is often extremely challenging to treat with both open and endovascular intervention often required. This patient presented with a ruptured aortic dissection which is rare and often immediately fatal. He survived urgent extensive aortic endovascular stenting, but, despite preventative measures, developed spinal cord ischaemia post-intervention. The contemporary management of acute aortic dissection, and the pathophysiology and prevention of spinal cord ischaemia are covered in this fantastic case report.
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