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Lola Garcia of Hemet, California, was the smallest infant in North America to undergo such a procedure.
Physicians at Lucile Packard Children’s Hospital Stanford have performed open-heart surgery without a blood transfusion on the smallest infant ever to undergo such a procedure in North America.
The surgery was done on a 10-day-old baby girl born in Hemet, California, with a serious congenital heart defect. Meticulous planning and execution of the surgery, an arterial switch procedure, allowed the medical team to surmount daunting technical challenges of treating a 7-pound open-heart patient without giving her a blood transfusion. It is the first “bloodless” open-heart surgery performed on an infant in the Western United States.
“If you can do surgery safely and effectively without transfusion, there are several medical benefits,” said Frank Hanley, MD, chief of pediatric cardiac surgery at the hospital’s Betty Irene Moore Children’s Heart Center and one of two surgeons who performed the procedure. He said patients who do not receive blood products have fewer post-surgical complications, provided they do not lose too much blood.
“You have to be able to do the surgery safely and not have the patient’s red blood cell count drop too low,” added Hanley, who is he Lawrence Crowley, MD, Professor in Child Health at the Stanford School of Medicine.
A severe heart defect
From the moment of her birth on Oct. 21, little Lola Garcia struggled to breathe. She and her parents, Felisa and Jared Garcia, were rushed to a children’s hospital near the family’s home.
Lola was diagnosed with transposition of the great arteries, a rare condition in which the heart’s major arteries are not connected correctly. Normally, the blood follows a single, figure-eight-shaped circuit through the heart and lungs, then back to the heart and out to the body to supply oxygen to organs. In Lola’s heart, the blood made two separate circuits — from the heart to the lungs and back, and from the heart to the body and back. The normal figure-eight was separated into two poorly connected loops. Her brain and other organs were not getting enough oxygen.
“They said she would definitely need heart surgery, and most likely a blood transfusion, to correct the problem,” said Felisa. “We were happy there was a solution, but when they said ‘transfusion,’ my heart dropped.” The Garcias are Jehovah’s Witnesses; they requested that Lola’s surgery be done without a blood transfusion because of their religious beliefs.
Although many hospitals now offer bloodless surgery for adults, the challenges of avoiding transfusion are much greater in newborns who need open-heart procedures. Several hospitals around the country turned the family down. But the pediatric cardiothoracic surgery team at Packard Children’s offered to attempt baby Lola’s arterial switch procedure without transfusing blood.
“Very few people have the technical expertise to do this,” said Vamsi Yarlagadda, MD, a clinical associate professor of pediatrics at the School of Medicine and the cardiologist at Packard Children’s who cared for Lola.
During surgery, Lola needed to be connected to a heart-lung machine, which would pump her blood through a circuit of tubing and membranes for re-oxygenation.
The machine’s tubing is primed with saline that mixes with the patient’s blood. For an adult, the volume of saline in a standard heart-lung machine does not dilute the blood enough to be dangerous, but a 7-pound newborn has less blood to begin with. Connecting Lola to a standard heart-lung circuit would have dangerously lowered her red blood cell count.
In the past, the problem has been solved by transfusing blood. For Lola, the Packard Children’s team took a different approach.
Read more: http://med.stanford.edu/news/all-news/2018/02/newborn-first-in-western-us-to-have-bloodless-open-heart-surgery.html
via TheWorldNewsOrgWorld News
New layer discovered in human eye
The discovery will make operations safer and simpler for patients with an injury in this layer.
Scientists have discovered a previously unknown layer lurking in the human eye.
The newfound body part, dubbed Dua's layer, is a skinny but tough structure measuring just 15 microns thick, where one micron is one-millionth of a meter and more than 25,000 microns equal an inch. It sits at the back of the cornea, the sensitive, transparent tissue at the very front of the human eye that helps to focus incoming light, researchers say.
The feature is named for its discoverer, Harminder Dua, a professor of ophthalmology and visual sciences at the University of Nottingham. Dua said in a statement that the finding will not only change what ophthalmologists know about human eye anatomy, but it will also make operations safer and simpler for patients with an injury in this layer.
"From a clinical perspective, there are many diseases that affect the back of the cornea, which clinicians across the world are already beginning to relate to the presence, absence or tear in this layer," Dua said in a statement.
Dua and colleagues, for example, believe that a tear in the Dua layer is what causes corneal hydrops, which occurs when water from inside the eye rushes in and leads to a fluid buildup in the cornea. This phenomenon is seen in patients with keratoconus, a degenerative eye disorder that causes the cornea to take on a cone shape.
Dua's layer adds to the five previously known layers of the cornea: the corneal epithelium at the very front, followed by Bowman's layer, the corneal stroma, Descemet's membrane and the corneal endothelium at the very back.
Dua and colleagues found the new layer between the corneal stroma and Descemet's membrane through corneal transplants and grafts on eyes donated for research. They injected tiny air bubbles to separate the different layers of the cornea and scanned each using an electron microscope.
The research was detailed in the journal Ophthalmology.
via TheWorldNewsOrgWorld News
Over the last year, FedEx has been working with Savioke, a Silicon Valley company that makes autonomous indoor delivery robots, to develop a robot delivery system for its repair facility in Collierville, Tennessee. The bots are used by workers to move items around the office, cutting down on wasted time, and storage space, as workers no longer have to spend time walking around picking up and dropping off items, or need a mailroom clerk to do it for them.
Savioke has spent the last few years building its Relay robot, a stout trashcan-height bot that can autonomously ferry about 10 pounds of goods around. The robot combines a range of technologies to see and navigate the world on its own, including lidar (the laser radar technologies powering the eyes of self-driving cars) and depth-sensing 3D vision cameras (similar to those found in a Microsoft Kinect). The company has been building relationships with hotels to use Relays as replacements for the menial tasks done by concierge and other hotel staff. Instead of a worker delivering room service or a toothbrush, hotels can now press a button on a tablet, have a Relay come to them, load it up, and send it to a guest, freeing up their time to do more important tasks.
Hotels need to install a wireless system in their elevators so that Relays can open the doors on their own. The bots, which can be rented from Savioke for $2,000 a month, can navigate through areas that have been mapped, even if there are new obstacles, such as chairs that have been moved around, or people. Relays have completed over 100,000 autonomous deliveries at a range of hotels owned by Sheraton, Aloft, Holiday Inn, Westin, and others. The robots make little beeps as they carry out their errands, and the touchscreen on their fronts tell passersby what they’re up to as they’re out. When they show up to a guest’s door, they open their cargo door, say hello on the screen, and let the guests interact by pushing a few buttons to say whether they were happy with their delivery. Savioke’s robots have also started popping up at a few other office facilities around the US:
Bloodless medical care seeks to avoid the need for transfusions. The following is a review of the most important considerations for setting up a bloodless care center.
“Bloodless” medical care was first recognized in the 1970s when Denton Cooley, MD, performed cardiac surgery on hundreds of patients who were Jehovah’s Witnesses (JW).1 These patients were often turned away by other physicians because they were prohibited from receiving allogeneic transfusions. Bloodless care became more common in the 1980s, when the risks for viral infections transmitted through transfusion reached an all-time high, especially for HIV and viral hepatitis. The practice of bloodless medicine was further developed and promoted by the Society for the Advancement of Blood Management (SABM), which was founded in 2001 and continues to specialize in this area today.
Bloodless care shares many principles in common with “patient blood management” (PBM),2 which aims to prevent and manage anemia, optimize coagulation to reduce or prevent hemorrhage, and promote optimal blood conservation, and to achieve these goals in order to improve outcomes with an evidence-based, patient-centered focus.3 PBM was an outgrowth of multiple randomized clinical trials, all of which compared a restrictive with a liberal transfusion strategy based on hemoglobin (Hb) triggers of 7 to 8 versus 9 to 10 g/dL, respectively, in which every trial showed either no benefit from or increased adverse outcomes with the liberal strategy.4-11 Perhaps these trigger trials were a natural progression from the high prevalence of viral risk that emerged in the blood supply during the 1980s or were efforts to reduce other transfusion-related risks and complications. Nonetheless, it is now generally accepted that “less is more” when it comes to transfusion, with the exception of ischemic brain and ischemic heart syndromes, for which the ideal Hb trigger is yet to be determined.12 Bloodless care can be thought of as extreme PBM, in which the goal is to avoid rather than reduce the need for transfusions.
In this article, we will review the top 10 issues to consider when setting up a bloodless program, which are summarized in Table 1.
While in Hollywood films hi-tech robots are portrayed as a threat, Chinese engineers might be able to change your mind. We take a closer look at the role artificial intelligence might play in the future
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