Daniel Barchi is Chief Information Officer of the Yale School of Medicine and the Yale-New Haven Health System. Before joining Yale, he was Senior Vice President and CIO of the $1.4 B Carilion Health System and led the integration of Carilion’s seven hospitals and 140 physician practices though implementation of a $98M electronic medical record.
Daniel was previously President of the Carilion Biomedical Institute and Director of Technology and Engineering for MCI WorldCom. In both roles was appointed as CEO, COO, and Chief Restructuring Officer of privately held and venture-backed companies in the healthcare and technology industries. Daniel began his career as a U.S. Naval officer and served at sea in cruisers. During his service, he was awarded the Navy Commendation Medal, the Southeast Asia Service Medal for service in the Red Sea, and the NATO Service Medal for operations in the Balkans.
Daniel holds a Bachelor of Science degree from Annapolis, the U.S. Naval Academy, and a Master of Engineering Management degree from Old Dominion University. He is active on several corporate and community service boards and he is a marathon runner.
Daniel Barchi is Chief Information Officer of the Yale School of Medicine and the Yale-New Haven Health System. Before joining Yale, he was Senior Vice President and CIO of the $1.4 B Carilion Health System and led the integration of Carilion’s seven hospitals and 140 physician practices though implementation of a $98M electronic medical record.
Daniel was previously President of the Carilion Biomedical Institute and Director of Technology and Engineering for MCI WorldCom. In both roles was appointed as CEO, COO, and Chief Restructuring Officer of privately held and venture-backed companies in the healthcare and technology industries. Daniel began his career as a U.S. Naval officer and served at sea in cruisers. During his service, he was awarded the Navy Commendation Medal, the Southeast Asia Service Medal for service in the Red Sea, and the NATO Service Medal for operations in the Balkans.
Daniel holds a Bachelor of Science degree from Annapolis, the U.S. Naval Academy, and a Master of Engineering Management degree from Old Dominion University. He is active on several corporate and community service boards and he is a marathon runner.
BcnInnova is a technology company located at Barcelon, Spain. Our mission is to use our expertice in computer based visión to provide technological solutions within the medical sector.
Content: About the company, business lines, products, contact information.
Awarded an A+ rating by the Better Business Bureau, Unique Insurance works with independent agents to provide automobile insurance. Unique Insurance is also a community advocate that supports the Fisher House Foundation.
The temporal branch of the facial nerve is a commonly injured nerve during facial trauma due to its superficial course over the zygomatic arch, and is a commonly damaged nerve during facial surgery.1 We report a case of trauma to the left temporal fossa, and subsequent unilateral forehead paralysis. Early exploration revealed external suture compression as the origin of his paralysis. Removal of the suture led to complete resolution of the neurological deficit. The differential diagnosis did not include the possibility of the compression of the nerve by a suture, however the decision for early exploration led to a full recovery.
BcnInnova is a technology company located at Barcelon, Spain. Our mission is to use our expertice in computer based visión to provide technological solutions within the medical sector.
Content: About the company, business lines, products, contact information.
Awarded an A+ rating by the Better Business Bureau, Unique Insurance works with independent agents to provide automobile insurance. Unique Insurance is also a community advocate that supports the Fisher House Foundation.
The temporal branch of the facial nerve is a commonly injured nerve during facial trauma due to its superficial course over the zygomatic arch, and is a commonly damaged nerve during facial surgery.1 We report a case of trauma to the left temporal fossa, and subsequent unilateral forehead paralysis. Early exploration revealed external suture compression as the origin of his paralysis. Removal of the suture led to complete resolution of the neurological deficit. The differential diagnosis did not include the possibility of the compression of the nerve by a suture, however the decision for early exploration led to a full recovery.
We report a case of acquired anterior thoracic lung herniation in a 63-year-old female. This painful herniation developed four years after uncomplicated video-assisted thoracic surgery for lung cancer resection and adjuvant radiation for concomitant breast cancer. The herniation site was remote from all prior incisions, and demonstrated intercostal muscle denervation and radiation fibrosis. The 8 cm x 10 cm chest wall defect was reconstructed with inlay PROCEED mesh and reinforced with a pedicled latissimus dorsi flap. Five months postoperatively the patient had complete resolution of symptoms, no evidence of herniation, and a stable wound.
This is initial data from the Figure 8 FlatWire Sternal Closure System. FlatWire is a simple, strong, and cost effective replacement for traditional steel wire for sternal cerclage.
This is a CME article that appears in Plastic and Reconstructive Surgery, the gold standard of publications within the field. Reconstructing the eyelid can be difficult and complicated. This article discusses the various approaches to defects caused by cancer.
This is a pilot study which examines the use of the fistbump instead of a traditional handshake in the hospital setting. In the hospital we use automatic doors, automatic sinks, and alcohol based hand sanitizer. However the rise of antibiotic resistant bacteria continues to increase. We propose ceasing handshaking within the hospital and opting instead for the fun fistbump will reduce the transmission of bacteria.
This is a paper that Dr. W. Thomas McClellan co-authored on the anatomy and reconstruction of the inframammary fold. This critical structure is often injured during breast augmentation and understanding of the anatomy is crucial to a good outcome in breast augmentation.
This is a powerpoint presentaiton given by W. Thomas McClellan, MD FACS, a Board Certified Plastic Surgeon who specializes in breast augmentation. This presentation is unique and critical because it gives patients detailed information about what is important regarding breast augmentation. For example: How to choose a surgeon, what is important in the operating room, postoperative care, how to pick a size, type of breast implant.
This is a paper which describes an innovative approach for skin sparing mastectomy. This incision tends to distract the eye and be less noticeable. Additionally it allows excellent access to the axilla for lymph node sampling and reduces the excessive retraction on the skin flaps.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Figure 8 Device Early Clinical Results
1. Prospective, randomized, single blinded trial of a novel
sternal fixation device
Paul Ghareeb1, Kee Lee2, W. Thomas McClellan1
1. Department of Surgery, Division of Plastic Surgery, West Virginia University School of Medicine, Morgantown WV
2. Department of Surgery, Division of Cardiothoracic Surgery, Monongalia General Hospital, Morgantown WV
Abstract Background (Cont) Results (Cont) Results (Cont)
Unstable steel wire cerclage following open heart surgery may result in Average Patient-Reported Pain Surgery to Discharge Cost
increased pain, risk of sternal cut-through, and dehiscence. These complications 10
90000
lead to longer hospital stays, increased cost, higher morbidity, and patient 9 $82,896
dissatisfaction. The Figure 8 Sternal Device is a novel construct which is simple, 8 80000
intuitive, and inexpensive. Prior bench-top testing has demonstrated superior
Pain (Visual Analog 10 Point Scale)
Dollars
7
strength and stiffness compared to standard steel wire. We present the initial $73,187
6
clinical data in our prospective, randomized, single blinded study utilizing this 70000
new FDA approved system. 5
4.5
Figure 8 Device
Steel Wire
30 patients undergoing elective complete sternotomies at a single 4
institution were randomly assigned to receive either the Figure 8 Sternal Device 3
2.8
60000
Figure 8 Device Steel Wire
or standard steel wire closure. All surgeries were performed by a single board 2
certified cardiothoracic surgeon. Data collected included: pump time, pump off 1
1.5
1 1 Cost was reduced by 12% on average in the Figure 8
to end time, design of closure, length of hospital stay, cost from time of surgery The Figure 8 Device shown above in the Transverse (left) and “X” (right)
to discharge, and pain on a visual analog pain scale on the day of discharge, day patterns.
0
Day of Discharge 30 Days
0.22
60 Days
Device cohort.
30, and day 60.
Patients receiving the Fig. 8 Device had a significant reduction in length of The authors hypothesized that the superior mechanical aspects Conclusions
stay compared to patients receiving steel wire (5.67 vs. 7.58 days respectively, of the Figure 8 Sternal Device would translate into significantly Patients receiving the Figure 8 Device reported
p<0.03). Additionally those with the Figure 8 Device reported significantly improved clinical outcomes by reducing post-operative pain, leading significantly reduced pain at day of discharge compared The preliminary results presented here suggest that the Figure 8
decreased pain at day of discharge (2.8 vs. 4.5 points on pain scale, p<0.02), with
to decreased length of stay and total cost. Sternal Device provides superior in-vivo stability, resulting in
equal pain scores at 30 and 60 days. Sternal closure time was increased by 25 to the steel wire cohort (2.8 vs. 4.5, p<0.02). Pain scores
percent in patients receiving the device vs. steel wires (70.82 vs. 53.17 minutes, improved clinical outcomes and decreased healthcare costs.
p=0.0002). Cost was 12 percent less, on average, for the device cohort.
were statistically equal at 30 and 60 days.
Prior bench-top testing of the Figure 8 Device demonstrated superior Patients in the device cohort experienced significantly reduced
Methods post-operative pain, leading to reduced length of stay. This reduction
strength and stiffness to standard steel wire. Early clinical results suggest that the Average Length of Post-Operative Stay
Figure 8 Sternal Device provides improved stability, which resulted in
9
in total number of hospital days resulted in decreased cost and
diminished post-operative pain at discharge, decreased length of stay, and 30 patients scheduled to undergo elective complete sternotomy at a 8 increased patient satisfaction.
7.58
reduced cost. Further clinical research is warranted to expand upon these initial single institution were randomly divided into two cohorts: one
7
trends and validate long term outcomes. group received the Figure 8 Device, while the other received standard Sternal closure time was slightly increased in the Figure 8 group,
steel wire cerclage. The patients were blinded to the type of closure 6 5.66
which may be explained by the fact that application of the device is
received. The same board-certified cardiothoracic surgeon performed 5
new to the surgeon. As surgeons become more proficient with the
Days
Background each procedure, and the configuration of the closure method was 4 device, one could expect closure times to improve.
determined by surgeon’s clinical judgment. X-rays at day of 3
Prior biomechanical testing demonstrated superior strength and
The consequences of sternal separation, cut-through, or discharge and 30 days confirmed alignment and proper placement 2
stiffness when compared to standard steel wire. Our results suggest
dehiscence can be profound, with a mortality rate of 10-40%1. The of sternal constructs.
1 that the enhanced mechanical characteristics of the Figure 8 Device
risk of complications increase in complex patients and in the elderly2- Pain was measured on a 10 point visual analog pain scale at day of 0
translate into improved clinical outcomes. By improving upon the
3. Over 760,000 procedures requiring sternotomy are performed
discharge, day 30, and day 60. Length of post-operative stay was
Figure 8 Device Steel Wire
current standard of care, the Figure 8 Sternal Fixation Device has the
every year, making complications a serious healthcare issue4-5. recorded, and total cost from surgery to discharge was calculated. potential to become the primary method of sternal closure.
Length of closure was estimated by using the cardiopulmonary Patients receiving the Figure 8 Device had significantly
The median hospital costs for patients developing sternal wound Further clinical research is necessary to expand upon our initial
complications following CABG can be up to 2.8 times higher than bypass pump off to surgery end time. Complications were reduced post-operative length of stay compared to those
data, and long term outcomes must be validated.
for uncomplicated patients (8). The Department of Health and documented. receiving steel wire (5.67 vs. 7.58 days, p<0.03) .
Human Resources has identified these complications as hospital- Statistical analyses were performed using SAS software (Version 9.2;
acquired events (HAC) for which hospitals should not receive Cary, NC); a student t-test was utilized to compare pain scores and
Average Bypass Pump off to
Surgery End Time
additional payment if the condition was not present upon admission. length of stay between the two groups. 80
70.82
References
The most important factor in the prevention of sternal events is 70
60 1. Shih CC, Shih CM, Su YY, Lin SJ. Potential risk of sternal wires. Eur J Cardiothorac Surg.
a stable sternal approximation following sternotomy 6-7.There have 50
53.16
2004 May;25(5):812-8.
Time (Minutes)
been many attempts to improve upon the standard method of steel Results 40
2. Ståhle E, Tammelin A, Bergström R, Hambreus A, Nyström SO, Hansson HE. Sternal
wire cerclage, but these systems have failed to gain widespread 30 wound complications--incidence, microbiology and risk factors. Eur J Cardiothorac Surg. 1997
adoption. Average Patient Age Average Patient Body Mass 20 Jun;11(6):1146-53.
70
62.75
Index (BMI)
62.5 10
3. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal
The Figure 8 Sternal Fixation Device was developed to provide a 60 34
0 wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001
sternal closure method that is superior to standard steel wire 50 32
30
30.1
29.4
Figure 8 Device Steel Wire
Dec;20(6):1168-75.
cerclage, while avoiding the flaws of current alternatives. Prior bench-
40
Years
28
4. Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a
BMI
30 26
top comparison of the Figure 8 Device to steel wires demonstrated 24 comprehensive review. Eur J Cardiothorac Surg. 2002 May;21(5):831-9.
Bypass pump off to surgery end time was used as an
20
that the device is 70% stronger when placed in a transverse 10
22
20 5. Voss B, Bauernschmitt R, Will A, et al. Sternal reconstruction with titanium plates in
configuration, and 40% stronger when constructed in the “X” 0
Figure 8 Cohort Steel Wire Cohort
18
Figure 8 Cohort Steel Wire Cohort
estimation of sternal closure time. Patients receiving the complicated sternal dehiscence. Eur J Cardiothorac Surg. 2008 Jul;34(1):139-45.
pattern8. In addition, the device demonstrated significantly reduced Figure 8 Device had significantly increased closure time 6. Casha AR, Gauci M, Yang L, Saleh M, Kay PH, Cooper GJ. Fatigue testing median
cut-through and improved lateral and longitudinal cyclical testing sternotomy closures. Eur J Cardiothorac Surg. 2001 Mar;19(3):249-53.
Patient age and BMI were statistically equal between the (70.82 vs. 53.17 minutes, p=0.0002).
when compared to steel wire cerclage8. 7. DiMarco RF, Lee MW, Bekoe S, Grant KJ, Woelfel G, Pellegrini RV. Interlocking figure-of-8
two cohorts. closure of the sternum. Ann Thorac Surg. 1989;47:927-929.
8. Wilson R, Ghareeb P, McClellan WT. Biomechanical analysis of the Figure 8 Sternal
Fixation Device. In press, Plast Reconstr Surg 2012.