While acknowledging the limitations and inadequate statistical power of the available evidence, this study suggests LAAO as a promising strategy for stroke reduction perioperatively and at the short-term follow-up without a significant increase in complications. Larger randomized studies in the future are required, with clearer surgical and anticoagulation protocols and adequate long-term follow-up, to validate the clinical efficacy of LAAO versus non-LAAO groups.

Background: Simplified Maze procedures involving radiofrequency, cryoenergy and microwave energy sources have been increasingly utilised for surgical treatment of atrial fibrillation as an alternative to the traditional cut and sew approach. In the absence of direct comparisons [1,2], a Bayesian network meta-analysis is another alternative to assess the relative effect of different treatments, using indirect evidence.Methods: A Bayesian meta-analysis of indirect evidence was performed using 16 randomised trials identified from 6 databases. Rank probability analysis was used to rank each intervention in terms of their probability of having the best outcome.Results: Sinus rhythm prevalence beyond 12 months follow-up was similar between the cut and sew, microwave and radiofrequency approaches, which were all ranked better than cryoablation (39%, 36%, 25% vs 1%). The cut and sew Maze was ranked worst in terms of mortality outcomes compared to microwave, radiofrequency and cryoenergy (2% vs 19%, 34%, 24%). The cut and sew Maze procedure was found to have significantly lower stroke rates compared to microwave ablation (OR <0.01; 95% CI, 0.00, 0.82), and had the highest chance of having minimal pacemaker requirements compared to microwave, radiofrequency and cryoenergy (81% vs 14%, 1%, <0.01%).Discussion: Bayesian rank probability analysis shows that the cut and sew approach is associated with the best outcomes in terms of sinus rhythm prevalence and stroke outcomes, and remains the gold standard approach for AF treatment. Given the limitations of indirect comparison analysis, these results should not be over-interpreted and should be viewed with caution.http://dx.

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Background: Establishing the relative merits of ministernotomy (MS) and minithoracotomy (MT) approaches to minimally invasive aortic valve replacement (MIAVR) is difficult given the limited available direct evidence. Network meta-analysis is a Bayesian approach that can combine direct and indirect evidence to better define the benefits and risks of MS and MT.Methods: Electronic searches were performed using six databases from their inception to June 2014.Relevant studies utilizing a minimally invasive approach for aortic valve replacement were identified. Data were extracted and analyzed according to predefined clinical endpoints. Both traditional and Bayesian metaanalysis approaches were conducted.Results: Compared to full sternotomy, MT was associated with longer cardiopulmonary bypass (CPB) duration (WMD, 9.99; 95% CI, 3.91, 16.07; I 2 =55%; P=0.001) and cross-clamp duration (WMD, 7.64; 95% CI, 2.86, 12.42; P=0.002; I 2 =74%). When compared to MS using network meta-analysis, no significant difference in duration was detected. Postoperative outcomes including 30-day mortality, stroke, and reoperation for bleeding and wound infection were comparable between MS and MT using both traditional and Bayesian meta-analysis techniques. Conclusions:The current evidence demonstrates that MIAVR via MS or MT is a safe and efficacious alternative to conventional median sternotomy. MT may be associated with longer CPB and cross-clamp durations, but has similar post-operative outcomes compared to MS. An individualized approach tailored to both the patient and surgical team is likely to provide optimal outcomes.

Ascorbic acid occurs naturally in many wine-making fruits. The industry also uses ascorbic acid as an antioxidant and color stabilizer in the making of alcoholic beverages including white wine, wine cooler, alcopop, and fruit liqueur. However, the degradation of ascorbic acid itself may cause browning and the deterioration of color quality. This study was aimed to monitor the degradation of ascorbic acid, the formation of degradation products, and the browning in storage of ascorbic acid containing 0-40% (v/v) ethanolic solutions buffered at pH 3.2 as models of alcoholic beverages. The results show that ascorbic acid degradation in the ethanolic solutions during storage follows first-order reaction, that the degradation and browning rates increase with the increase of ethanol concentration, that the activation energy for the degradation of ascorbic acid is in the range 10.35-23.10 (kcal/mol), that 3-hydroxy-2-pyrone is an indicator and a major product of ascorbic acid degradation, and that aerobic degradation pathway dominants over anaerobic pathway in ascorbic acid degradation in ethanolic solutions.

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of the tracheostomy group. Seven of these 23 patients had DSWI after insertion of tracheostomy. DSWI was significantly higher in tracheostomy versus no-tracheostomy patients (10.2% vs. 0.48%; P<0.001). DSWI was also associated with higher mortality rates compared to non-DSWI patients (11.4% vs. 2.3%; P<0.001).Conclusions: The present study demonstrated that tracheostomy was an independent risk factor for post-sternotomy DSWI, and that DSWI was a predictor of mortality. For tracheostomy patients, coronary artery bypass grafting (CABG) procedures and longer durations of tracheostomy were strong predictors of DSWI. Across all sternotomy patients, tracheostomy, diabetes, urgency status and blood transfusions were significant risk factors for DSWI. As such, the decision for tracheostomy post-sternotomy should be carefully considered on a case by case basis.