Open Vein Research Articles

Chemothromboprophylaxis in varicose vein surgery: a systematic review.

Venous thromboembolism (VTE) is a possible complication after varicose vein surgery, reported after both open and endovascular interventions. Nonetheless, there are no internationally accepted recommendations regarding postoperative VTE prevention strategies, with some authors advocating for its use, while others recommend against it. This study aims to systematically review current evidence on the efficacy and safety of chemothromboprophylactic strategies after varicose vein surgery. A literature search was performed on the MEDLINE, Scopus, SciELO and Web of Science databases, which returned 532 studies. Ten studies were included. Data were extracted using piloted forms. A total of 6929 patients were included for analysis, out of which 70.4% were treated by open surgery (N.=4878) and 29.6% by endovenous procedures (N.=2051; 79.1% EVLA; 20.9% RFA). VTE chemothromboprophylaxis was performed in 76.3% of the patients (N.=5284), from which 62.5% were treated by open surgery (N.=3301) and 37.5% by endovenous interventions (N.=1983). Among those treated by open surgery, reported deep venous thrombosis (DVT) rates ranged between 0-6.25%, while pulmonary embolism (PE) was reported in 0-0.07% of the cases. Regarding endovenous interventions, EHIT and DVT rates ranged between 0-2.5% and 0-0.9%, respectively, with no cases of PE described. The remaining 23.7% of the patients did not underwent VTE chemothromboprophylaxis (N.=1645), with DVT and PE rates after open surgery ranging between 0-5.17% and 0-1.48%, respectively. Only one study reported thrombotic complications after endovenous interventions in this subgroup of patients, with postoperative EHIT rates of 7.3%, and no information regarding PE or DVT. Bleeding complications were higher in patients undergoing chemothromboprophylaxis (0-10.2%) when compared to those who did not (0-0.18%), and were more frequent after endovenous interventions (0-10.2% versus 0-0.75% after open surgery). VTE is a possible complication after both open and endovascular varicose vein procedures, although overall VTE complications occur less frequently after endovascular interventions. There's a clear heterogeneity regarding peri and postoperative chemoprophylaxis regimens used. Further studies are required to stratify risk factors and indications for chemothromboprophylaxis after varicose vein surgery.

Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery for Left Main Disease Trial

BackgroundWe investigated outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH) within the Evaluation of XIENCE Versus CABG (EXCEL) trial. MethodsAll patients in EXCEL randomized to CABG were included in this study. For this analysis, the primary end points were ischemia-driven revascularization (IDR) and graft stenosis or occlusion at 5 years. Additional end points were as follows: a composite of death from any cause, stroke, or myocardial infarction; bleeding; blood product transfusion; major arrhythmia; and infection requiring antibiotics. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. ResultsOf the 957 patients randomized to CABG, 686 (71.7%) received at least 1 venous graft with 257 (37.5%) patients in the EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3% vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%; P = .94), and infection requiring antibiotics within 1 month (13.6% vs 16.8%; P = .27) were similar between EVH and OVH patients. Major arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month (21.8% vs 15.4%; P = .03) was higher in EVH patients. ConclusionsIDR at 5 years was higher in the EVH group. EVH and OVH patients had similar rates of graft stenosis or occlusion and the composite of death, stroke, or myocardial infarction at 5 years.

Study on Reflection-Based Imaging Finger Vein Recognition

Finger vein modality plays an important role in biometrics due to its stability and security. However, existing state-of-the-art finger vein recognition systems adopt the transmission-based imaging mode with a sealed design, which requires redundant space in the imaging device and results in an uncomfortable user experience. Consequently, we design a reflection-based imaging device with an open structure to reduce the device volume and improve the portability, as well as the user experience. However, an open structure of the device inevitably introduces extra illumination variation to the image, which may deteriorate the performance of the system. In this paper, we propose Domain Adaptation Finger Vein Network (DAFVN) to narrow the domain shift between different illumination data domains and extract illumination-invariant features from finger vein images, improving the robustness to illumination variations. To evaluate the performance of DAFVN and remedy the lack of a publicly open reflection-based finger vein database, we use the self-made device to construct the first large-scale reflection-based finger vein database, namely SCUT Reflective Imaging Finger Vein database (SCUT-RIFV). It includes 32,064 images from 167 subjects with five different illumination conditions. Abundant experiments implemented on the SCUT-RIFV database indicate that the proposed method can effectively alleviate the influence of illumination variation on the reflection-based finger vein recognition system.

Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery.

The saphenous vein is the most used conduit for coronary artery bypass surgery. However, the patency rate of this graft is inferior to the internal thoracic artery patency rate, which is the gold standard. Using the conventional technique, the saphenous vein is harvested via a large open incision and excised in such a way that causes both vascular damage and wound healing complications. Consequently, vein graft patency and surgical site infection may be compromised. Graft patency is markedly improved when the saphenous vein is harvested atraumatically with minimal damage and with surrounding cushion of perivascular fat intact. However, despite the improved graft performance, wound healing complications and infection remain a problem. Although wound healing complication is reduced when using endoscopic vein harvesting, there may be a negative impact on graft performance. This is due to vascular damage associated with application of forces to the vein that are usually avoided in open vein harvesting, including traction, adventitial stripping, and venous compression. There is evidence to suggest that improved patency of endoscopically harvested saphenous veins is associated with the surgeon’s experience of the technique. Recently, endoscopic methods of harvesting have been described where the saphenous vein is removed intact and with minimal vascular damage caused. In addition, wound healing complications, infection, and scarring are reduced. While the effect of these techniques on vein graft patency have yet to be reported, the ability to obtain a superior graft with reduced wound complications will be of great benefit to patients undergoing coronary revascularization procedures.

Comparison of the Outcomes after Endoscopic Vein Harvesting Versus Open Vein Harvesting for Coronary Bypass Surgery

Minimally invasive endoscopic vein harvesting (EVH) was first reported in 1996 as an alternative to open vein harvesting (OVH). Making coronary artery bypass surgery a less invasive procedure, shortly after its introduction, it became the standard of care for conduit harvesting. When compared to the conventional technique, the incidence of site infections wound dehiscence, delayed healing, duration of hospitalization, and postoperative pain were markedly reduced.

Heparin versus No Heparin before Endoscopic Vein Harvesting using Angioscopy

Background: Endoscopic vein harvesting (EVH) became a standard technique with several advantages over open vein harvesting (OVH). Thrombus formation inside the vein lumen is one of the main concerns after EVH. It is not known whether heparin use before EVH could prevent this complication. The study aimed to assess the safety of not giving intravenous heparin before starting the open system EVH procedure using the PeriVu™ Disposable Angioscopy (LeMaitre® VASCULAR- France) as a modality to assess the intraluminal vein clots.
 Methods: This research is a randomized study that compared two groups of patients undergoing CABG. One group had 2500 IU heparin before EVH using (Virtusaph plus, Terumo) (n=50) and the other group had EVH without giving heparin (n=50). Intraluminal clots in the vein segments were evaluated using PeriVu Disposable Angioscopy ( LeMaitre-VASCULAR).
 Results: Preoperative data were comparable between groups with no statistically significant difference. The mean duration of the procedure in the heparin group versus the non-heparin group was 30.6±5.8 and 28.7±5.9, respectively (P= 0.11). Intraluminal clots were detected in two segments out of 103 segments (1.94%) in the No heparin group, while none was detected in the heparin group (P= 0.24).
 Conclusion: There was no difference between heparin versus no heparin during endoscopic vein harvest regarding intraluminal thrombus formation. Further studies are recommended to confirm our findings.

Robotic first rib resection for thoracic outlet syndrome.

Robotic resection of the “offending portion” of the first rib in patients with thoracic outlet syndrome (TOS) has been associated with excellent results. The results have been due to (I) a better understanding of the pathogenesis of TOS, and (II) the technical advantages of the robotic platform. This article outlines the recent understanding of the pathogenesis of TOS, and reports the experience with robotic resection of the “offending portion” of the first rib in patients with neurogenic and venous TOS. Patients diagnosed with TOS underwent robotic first rib resection. Diagnosis of TOS was made by magnetic resonance angiography (MRA). On a thoracoscopic platform, the robot was used to dissect the “offending portion” of the first rib. A total of 162 patients underwent robotic first rib resection. Eighty-three patients underwent robotic first rib resection for Paget-Schroetter syndrome (PSS) (venous TOS). There were 49 men and 34 women. Mean age was 24±8.5 years. Operative time was 127.6±20.8 minutes. Median hospitalization was 4 days. There were no surgical complications, neurovascular injuries, or mortality. At a median follow-up of 24 months, all patients had an open subclavian vein (SV) for a patency rate of 100%. Seventy-nine patients underwent robotic first rib resection for neurologic symptoms of the upper extremity (neurogenic TOS). There were 29 men and 50 women. Mean age was 34±9.5 years. Operative time was 87.6±10.8 minutes. There were no intraoperative complications. Hospital stay ranged from 2–4 days with a median hospitalization of 3 days. There were no neurovascular complications. There was no mortality. In patients with neurogenic symptoms, Quick DASH Scores (mean ± SEM) decreased from 60.3±2.1 preoperatively to 5±2.3 in the immediate postoperative period, and 3.5±1.1 at 6 months (P<0.0001). Immediate relief of symptoms was seen in 71/79 (91%) patients. Persistent paresthesia was seen in 9/79 (9%) immediately postop and 3/79 (3.8%) patients at 6 months. Following the appropriate identification of the “offending portion” of the first rib which results in compression of the SV at its junction with the innominate vein by MRA, robotic resection of the “offending portion” of the first rib allows is associated with excellent results.

A review of the best method of leg wound closure following open harvesting of the long saphenous vein for coronary artery bypass grafting

Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. Consequently, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘following open long saphenous vein harvesting in adults undergoing CABG, is single-layer leg wound closure superior to multiple-layer closure in terms of post-operative complications encountered? ‘. Altogether 382 papers on Ovid Embase and Ovid Medline, 301 papers on PubMed and 11 papers on the Cochrane database were found using the reported search. From the screened articles, 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best method of leg closure following open saphenous vein harvesting for CABG is single-layer cutaneous closure. The use of a suction drain to eliminate the dead space should be considered on a case-to-case basis by the lead operating surgeon with the patient's characteristics and their own expertise in mind.

Harvesting techniques of the saphenous vein graft for coronary artery bypass: Insights from a network meta-analysis.

The optimal harvesting technique of saphenous vein (SVG) in coronary artery bypass grafting (CABG) is still to be elucidated. The present study aimed to compare the methods of SVG harvesting technique, which were open vein harvesting (OVH), endoscopic vein harvesting (EVH), and no-touch vein harvesting (NT), using a network meta-analysis of randomized controlled trials (RCTs), and propensity-score matched (PSM) studies. MEDLINE and EMBASE were searched through April 2021 to identify RCTs and PSM studies that investigated the outcomes in patients who underwent CABG with the SVG using one of three methods; OVH, EVH, and NT. The outcomes of interest were all-cause mortality, the rates of revascularization, and graft failure. Risk ratios (RRs) were extracted for the rates of graft failure, and hazard ratios (HRs) were extracted for all-cause mortality and the rates of revascularization. Eligible seven RCT and five PSM studies were identified which enrolled a total of 8111 patients. All-cause mortality was significantly lower in patients with EVH compared with OVH (HR [95% confidence interval (CI)] =0.77 [0.65-0.92], p = .0032). The rates of revascularization were similar among the groups. The rate of graft failures was significantly lower in patients with NT compared with OVH (HR [95% CI] =0.54 [0.32-0.90], p = .019) and with EVH (HR [95% CI] =0.39 [0.17-0.86], p = .023). NT vein harvesting is favorable for graft patency, and OVH showed higher all-cause mortality than EVH. Further well-powered RCTs are needed to confirm our findings.

A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery.

BackgroundUtilisation of the Endoscopic Vein Harvesting (EVH) technique has been increasing for coronary artery bypass grafting (CABG) for the last two decades. Some surgeons remain concerned about the long-term patency of the long saphenous vein harvested endoscopically compared to traditional Open Vein Harvesting (OVH). The aim of this study was to perform a retrospective analysis of the outcomes between EVH and OVH from three UK centres with 10 years follow-up.Methods27,024 patients underwent CABG with long saphenous vein harvested by EVH (n=13,794) or OVH (n=13,230) in three UK centres between 2007 and 2019. Propensity modelling was used to calculate the Inverse Probability of Treatment Weights (IPTW). The primary endpoint was mortality from all causes and secondary endpoints were length of hospital stay, postoperative complications, and incidence of repeat coronary re-vascularisation for symptomatic patients. IPTW was used to balance the two intervention groups for baseline and preoperative co-morbidities.ResultsMedian follow-up time was 4.54 years for EVH and 6.00 years for OVH. Death from any cause occurred in 13.8% of the EVH group versus 20.8% in the OVH group over the follow-up period. The hazard ratio of death (EVH to OVH) was 0.823 (95% CI: 0.767, 0.884). Length of hospital stay was similar between the groups (p=0.86). Post-operative pulmonary complications were more common in EVH vs OVH (14.7% vs. 12.8%, p<0.001), but repeat coronary re-vascularisation was similar between the groups.ConclusionThis large retrospective multicentre analysis indicates that EVH has a lower risk of mortality compared with OVH during the follow-up period of the study. The observed benefits of EVH may outweigh the risks but should be considered on a case-by-case basis. We hope this review gives confidence to other cardiac centres that offering an EVH approach to conduit harvesting does not affect long term patient outcomes.

Extended hepatectomies: Our experience from low volume center

Improved perioperative care combined with proper training has helped in achieving excellent outcomes following liver surgery even in low volume centers. Extended resections require additional surgical skills as well as perioperative care and when done in proper has equally good results. Here, we present the outcome of extended liver resections performed in developing HPB unit of low volume center. Retrospective review of the medical records of all the patients undergoing extended hepatectomies were analyzed. Total 86 liver resections were performed, out of which 61 were major liver resections (three or more segments) performed over 6 years period. Out of them, total 11(18% of major liver resections) extended hepatectomies have been performed. All were right extended hepatectomies only. For liver augmentation, 2 underwent successful right side and segment 4b portal vein embolization, 2 patients had open right side portal vein ligation and one had ALPPS procedure. Rest of the patients didn't require any augmentation procedures. Postoperatively, 1 patient had grade 3 PHLF, 2 grade 2 PHLF and resolved, 2 bile leaks and resolved. Patient with ALPPS procedure had grade 3 PHLF has died on 3rd postoperativ week. Rest 10 patients were discharged on average of 12 hospital days. Better patient selection combined with proper training and improved perioperative care, extended hepatectomies can also be safely performed with acceptable outcomes even in low volume centers of developing nations.

Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery.

Endovascular techniques continue to be increasingly utilized to treat vascular disease, but the effect of these minimally invasive techniques on opioid use following surgery is not known. Using Medicare data, we identified opioid-naive patients undergoing vascular procedures between 2009 and 2017. We selected patients ≥65years old with continuous enrollment 12months before and 6months after surgery and had no additional operations. We defined new persistent opioid use (NPOU) as one or more opioid prescription fills both between 4-90 and 91-180days postoperatively. Multivariable regression was performed for risk adjustment, and frequencies of NPOU were estimated between endovascular and open techniques to compare surgical approach. A total of 77,767 patients were identified, with 2.6% of all patients developing new persistent use. In addition to the identification of several risk factors for new persistent use, patients undergoing endovascular carotid or vertebral interventions were found to have higher adjusted frequencies of persistent use compared to those undergoing open interventions (3.0% vs. 1.8%, p < 0.001) as did those undergoing endovenous compared to open vein procedures (2.2%, vs. 1.6%, p = 0.019). We found no difference for peripheral vascular or aortic/iliac procedures. Patients undergoing vascular surgery are at high risk for new persistent use. Undergoing endovascular carotid or venous surgery was associated with an increased risk of NPOU, whereas no differences were found between endovascular and open approaches for peripheral arterial or aortic disease.

Lower carboniferous fractured carbonates of the Campine Basin (NE-Belgium) as potential geothermal reservoir: Age and origin of open carbonate veins

Within the Lower Carboniferous limestones in the boreholes of Poederlee, Heibaart and Turnhout (Campine Basin, NE-Belgium), open veins partially cemented by calcite and dolomite are considered important with regard to the geothermal reservoir potential of these limestones. Based on a detailed petrographic analysis, stable carbon and oxygen as well as clumped Δ47 isotope analysis and U/Pb age dating, the formation conditions of these veins have been reconstructed and were placed in the geodynamic evolution of the sedimentary basin. All host rocks are recrystallized, and the open carbonate vein cements often possess a similar depleted δ18OPDB signature as their recrystallized host rock. The latter thus indicates vein cement precipitation was likely rock-buffered. The δ13C signature of the host rock often displays a marine signature, while in the veins two isotopic clusters can be differentiated. The first cluster groups veins with cleavage twins, and are characterized by slightly to moderately depleted δ13C, reflecting a mixture of marine carbon with carbon derived from organic matter. This group typically occurs in the open veins from the microbially dominated Poederlee and Heibaart buildups characterised by on-lapping organic-rich Namurian black shales. One of these veins formed at 216 ± 6 °C, indicating that it crystallised during the Sudetic – Asturian deformation stage of late Carboniferous age, while others formed between 110 and 130 °C, indicating that they could have been formed during the late Carboniferous burial stage or after the Sudetic – Asturian deformation and uplift. The second cluster groups veins that may, but often do not, contain cleavage twins. They show host-rock buffered δ13C signatures. These veins have a Cretaceous (late Aptian/early Albian) and/or Paleocene U/Pb age and formed at temperatures dominantly between 50 and 80 °C based on clumped isotopes.

E-selectin inhibitor is superior to low-molecular-weight heparin for the treatment of experimental venous thrombosis

BackgroundThis study evaluated E-selectin inhibition with GMI-1271 (Uproleselan [GMI]) alone and in combination with the standard of care low-molecular-weight heparin (LMWH) to improve vein recanalization, decrease vein wall inflammation and protect against adverse bleeding in a primate model. We sought to examine this novel treatment of venous thrombosis. MethodsUsing a well-documented primate animal model, iliac vein thrombosis was induced by balloon occlusion of the iliac vein for 6 hours. Starting on day 2 after thrombosis, animals began treatment in two phases. In phase one, nontreated controls received no treatment (n = 5) vs animals treated with the E-selectin inhibitor GMI, 25 mg/kg, subcutaneous (SC), once daily (n = 4) for 21 days (previously published data). In phase two, animals were treated with GMI plus a combination of LMWH 1.5 mg/kg or 40 mg (GMI + LMWHc) SC once daily (n = 8) for 19 days; and animals treated with LMWH 1.5 mg/kg or 40 mg (LMWHc) SC once daily (n = 6) for 19 days. Animals were evaluated by magnetic resonance venography for vein recanalization and inflammation by gadolinium extravasation, duplex ultrasound, coagulation tests (thromboelastography, bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen) and complete blood count at baseline, days 2, 7, 14, and 21 at euthanasia. Statistical analysis included using unpaired t test with Welch's correction for direct comparisons and one-way analysis of variance for comparison between the groups. ResultsPercent vein recanalization by magnetic resonance venography was highest in the GMI alone group followed by GMI + LMWHc, both significantly different from control. On ultrasound examination, animals treated with GMI alone had no decrease in open vein lumen by day 21, whereas decreases were observed in groups GMI + LMWHc (–26%), LMWHc (–27%), and controls (–80%). Vein wall inflammation decreased significantly in all treated groups. Intimal fibrosis and intimal thickness was best preserved in the GMI alone group. An analysis of total vein wall collagen revealed a trend in all treatment groups of decreasing vein wall collagen. No clinically significant bleeding events were noted in any group. The LMWH groups trended to have prolonged coagulation test values, whereas E-selectin inhibition with GMI did not cause clinically significant changes in coagulation measures. ConclusionsTreatment with E-selectin inhibition results in improved vein recanalization, a decrease in vein wall inflammation and vein wall intimal thickness and fibrosis, with no changes in markers of coagulation. E-selectin inhibition with GMI alone is superior to E-selectin inhibition combined with LMWH, LMWH alone, and no treatment in this deep vein thrombosis model of iliac vein thrombosis.

Intermediate-Term Outcomes of Endoscopic or Open Vein Harvesting for Coronary Artery Bypass Grafting

This randomized clinical trial examines intermediate-term outcomes of endoscopic vs open vein harvesting for coronary artery bypass grafting as part of the Randomized Endo-Vein Graft Perspective (REGROUP) trial.

Tumefactive demyelinating lesion (TDL)

Tumefactive demyelinating lesion(TDL)is defined as a large lesion, size >2 cm, mass effect, perilesional edema and/or ring enhancement. TDL could occur in multiple sclerosis(MS), neuromyelitis optica spectrum disorder(NMOSD), acute disseminated encephalomyelitis(ADEM)or other immunological diseases. Non-invasive methods including MR imaging and assay of several autoantibodies(e.g. aquaporin-4 autoantibodies)are recommended when each TDL is identified. The radiological findings on MRI are characterized by size >2 cm, mass effect, perilesional edema, T2 weighted hypointense rim, peripheral diffusion restriction, open ring enhancement, vascular enhancement, and central vein sign. When atypical clinical and radiological presentations are present in patients with TDL, diagnosis may necessitate brain biopsy due to exclude alternative pathology(e.g. primary central nervous system lymphoma). Because treatments and outcomes for patients with TDL are dependent on each disease etiology including MS, NMOSD, ADEM or others, we should always clarify the entire picture behind the disease.

Endoscopic vein harvesting.

Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009–2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.

Leaf vein pattern response to heat and drought requires genes that influence PINFORMED1 localization and is mimicked by ABA treatment

The plasticity of plant development allows acclimation to environmental stresses such as heat and drought. For example, increased vein density with more vein meetings is proposed to provide more efficient and robust water delivery when water availability is reduced. We demonstrate that Arabidopsis leaves respond to short term heat or drought by increasing leaf vein density, which in heat includes a higher density of vein meetings. We find that a set of genes, UNHINGED, FORKED1, FORKED-LIKE1, 2 and 3, which influence PINFORMED1 localization and control vein meeting in developing leaves, is required for the vein pattern response to heat or drought. Comparison of δ13C (‰) and nitrogen (%) under different conditions suggests that while wild type and mutant genotypes enriched δ13C (‰) under drought conditions, only wild type increased total shoot nitrogen suggesting increased photosynthetic assimilation. One explanation is that the mutants’ open vein pattern fails to supply sufficient water to support increased photosynthesis. Finally, treatment with ABA caused changes to leaf vein pattern similar to heat or drought treatment, a response that was eliminated in the abscisic acid insensitive1 but not the forked1 genotype. This suggests that the vein pattern response to reduced water availability may in part be controlled by ABA.

Comparison of Life Quality in Patients Undergoing Open Vein Harvesting and Endoscopic Vein Harvesting Techniques: A Prospective Cohort Study

Background: As the traditional indicators of the operative outcomes, including morbidity and mortality, cannot give sufficient information on a patient’s physical, mental, emotional, and functional well-being alone, we aimed to compare life quality in the patients under open vein harvesting (OVH) and endoscopic vein harvesting (EVH) techniques after four years of follow-up. Methods: This prospective cohort study followed all the patients who were scheduled for off-pump CABG in the Mashhad-based Imam Reza Hospital, in October 2013, for 4 years. Accordingly, data related to their quality of life were collected, and their life quality was then compared using the WHOQOL-BREF scale. Chi-squared, t-test, Fisher exact test, and relative risk were also used. Results: This study was conducted on a total of 103 patients under the two techniques of OVH (n = 53) and EVH (n = 50). The difference between the EVH (4.7%) and OVH (16.3%) groups at the demographic characteristics was the Transient Ischemic Attack (P = 0.023). After a 4-years follow-up period, no significant differences were observed between the patients undergoing the two techniques of OVH and EVH in all the domains of life quality. Conclusions: According to the obtained results, there was no difference in the quality of life between the patients undergoing OVH and EVH techniques over a four-year period. In this regard, further investigations are recommended on the quality of life in patients under the two techniques of OVH and EVH with long-term follow-up periods.

Total Intravenous Anesthesia (TIVA) With Propofol for Acute Postoperative Pain: A Scoping Review of Randomized Controlled Trials.

Total intravenous anesthesia (TIVA) with propofol may improve acute postoperative pain control compared to inhalational anesthesia. The objective of this review was to comprehensively update and evaluate the existing literature on the analgesic efficacy of propofol TIVA. A systemized literature search for randomized controlled trials in adult patients was conducted in the PubMed and Cochrane CENTRAL (EMBASE source) databases up to August 2019. Clinical trials included compared propofol TIVA against inhalational isoflurane, sevoflurane, or desflurane. Only clinical trials that studied acute postoperative pain scores or analgesic consumption as a primary outcome were included. Sixteen randomized controlled trials were included. Surgical procedures evaluated included: radical gastrectomy, open vein stripping, breast cancer surgery, laparoscopic cholecystectomy, inguinal herniotomy, abdominoplasty, bariatric surgery, lumbar spine surgery, emergency neurosurgical operations, open and laparoscopic gynecological surgeries, and dental surgery. Propofol TIVA was associated with reduced postoperative pain scores and/or decreased opioid consumption in 9 out of 16 clinical trials. There was no difference in 5 clinical trials, and propofol TIVA was associated with worse analgesic outcomes in 2 trials. Propofol TIVA may improve acute postoperative analgesia after surgery, but different factors such as surgical procedures and anesthetic/analgesic techniques may influence its effectiveness.