Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. \"No-Touch\" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.

The external stenting of saphenous vein grafts (SVGs) during coronary artery bypass grafting (CABG) has been proven to reduce intimal hyperplasia (IH) in animal models, paving the way for human randomized controlled trials (RCTs) to be conducted. Herein, we performed a study-level meta-analysis to assess the impact of the Venous External SupporT (VEST) device, an external stent, on the outcomes of SVGs. A systematic search was conducted to identify all RCTs comparing VEST-stented to non-stented SVGs in patients undergoing CABG. The primary outcome was graft occlusion. The main secondary outcomes were repeat revascularization, SVG IH area, and intimal-medial thickness. Two RCTs totaling 407 patients were included. At a mean follow-up of 1.5 years, there was no difference in graft occlusion between groups (incidence rate ratio: 1.11; 95% confidence interval (CI): 0.80-1.53). The rate of repeat revascularization was also similar (odds ratio: 0.66; 95% CI: 0.27-1.64). The IH area (standardized mean difference (SMD): -0.45; 95% CI: -0.79 to -0.10) and intimal-medial thickness (SMD: -0.50; 95% CI: -0.90 to -0.10) were significantly reduced in the VEST group. Our findings show that significant reductions in the IH area and the intimal-medial thickness in VEST-stented SVGs do not currently translate into a lesser need for repeat revascularization or less graft occlusion events compared to non-stented SVGs at 1.5 years after CABG.

Saphenous vein grafts (SVGs) are the most frequently used conduits in coronary artery bypass grafting (CABG), but their higher rate of occlusion compared to arterial conduits remains a concern. Previous studies have shown that SVG failure is mainly driven by intimal hyperplasia, an adaptative response to higher pressures of the arterial circulation. The VESTTM device (Vascular Graft Solutions, Tel Aviv, Israel), an external support designed to mitigate intimal hyperplasia in SVGs, has been tested in few clinical trials (RCTs). Herein, we descriptively evaluated the randomized evidence on the VEST device.

BACKGROUND: There is strong evidence for the benefits of exercise for people with Multiple Sclerosis (MS), however, up to 80% of people with MS report experiencing exacerbated symptoms with elevated body temperatures. A range of cooling garments to assist people with MS manage symptoms of heat sensitivity have been investigated. Therefore, the aim of this systematic review was to assess the effect of cooling garments to improve physical function in people with MS, and to determine any associated physiological and perceptual responses.
METHODS: A systematic review adhering to the PRISMA guidelines was performed. The eligibility criteria required investigations to have conducted a randomized controlled trial or cross-over study to assess the effect of a cooling garment to improve physical function, or a related physiological or perceptual measure, in people with MS.
RESULTS: Thirteen empirical studies were identified, compromising of acute cross-over designs (61.5%), longitudinal parallel group designs (23.1%) or a combination of both (15.4%). The studies included 384 participants with MS with an expanded disability status scale range of 1-7.5. Garments included liquid-perfused cooling vests/tops/hoods (50.0%), phase-change cooling vests (38.9%), a cooling thigh-cuff (5.6%) and a palm cooling device (5.6%). The cooling garments were effective at improving walking capacity and functional mobility, and some studies demonstrated improvements in muscular strength and balance, but not manual dexterity. The garments also resulted in improved core temperature, skin temperature, thermal sensation and subjective fatigue. Improvements occurred in temperate and warm conditions, and both with and without an exercise stimulus.
CONCLUSIONS: Cooling garments can improve physical function for people with MS. Since none of the cooling garments caused harm, and no particular cooling garment could be identified as being superior, people with MS should experiment with different cooling garments to determine their preference, and industry should focus on cooling garments that are effective, accessible and user-friendly.

Knowledge gaps exist on association between law enforcement officer (LEO) anthropometric characteristics and perceived body armour fit, armour discomfort, and armour-caused pain. This study assessed the correlation and identified influential torso dimensions for armour sizing and design applications. Nine-hundreds and seventy-four LEOs across the U.S. participated in a national study on LEO armour use and body dimensions. Perceived ratings of armour fit, armour discomfort, and body pain were found moderately correlated with each other. In addition, armour fit ratings were associated with certain torso anthropometric characteristics, such as chest circumference, chest breadth, chest depth, waist circumference, waist breadth (sitting), waist front length (sitting), body weight, and body mass index. LEOs who reported armour poor fit, armour discomfort, and armour-caused pain had a larger mean of body dimensions than the \"armor good fit\" group. More women than men had poor fit, discomfort, and body pain in the use of body armour.Practitioner summary: The identified influential body measurements can be used as the \"drivers\" for multivariate analyses to develop an improved armour sizing system to further LEO protection. The study also suggests consideration of gender specific armour sizing systems to accommodate differences in torso configurations between male and female officers and to resolve the concern that more female officers had poor armour fit than male officers.

VEST III trial is the largest randomized controlled trial to date to evaluate the role of external stents on late graft failure. In this study, an external stent was applied to vein grafts and compared with another unsupported vein graft in the same patient. The groups were compared for overall graft patency and intimal hyperplasia. Patent vein grafts were further assessed and graded based on the Fitzgibbon patency scale. This review discusses the strengths and weaknesses of the trial.

Nonhuman primates are used extensively in a variety of nonclinical safety evaluation studies of new drugs. In those studies, intravenous infusion is a common treatment method, a noninvasive telemetry system is usually used for cardiovascular safety and pharmacology evaluation, and blood samples are repeatedly collected for various analysis. Intravenous infusion, vest wearing, and repeated intravenous blood collection can caused a stress response in cynomolgus monkeys, which may lead to changes in clinical pathology parameters in them. Here, we aimed to test the effects of the above operations on clinical pathology parameters in cynomolgus monkeys. Twenty monkeys (10 male/10 female) were administered 0.9% sodium chloride injections via intravenous infusions on Days 1 and 10. Each animal wore a vest before each dosing, and the vest was removed at 24 h after each dosing. Blood samples were collected before the first dose and at 2 min, 24 h, 48 h, 72 h, and 168 h after each dosing. As compared to values before the first dose (D-1) increases in reticulocytes (percentage and absolute count) and decreases in erythrocytes (red blood cells, hemoglobin, and hematocrit) were noted after dosing. The decrease in erythrocytes and increase in reticulocytes were considered to the related to the repeated intravenous blood collection. Increases in leukocytes (white blood cells and absolute count and percentage of neutrophils) and platelets (mean platelet volume and platelet distribution width) were noted at 2 min or 24 h post dose. Increases in aspartate aminotransferase, direct bilirubin, creatine kinase, C-reactive protein, and human cardiac troponin I and decreases in inorganic phosphate were noted at 2 min to 72 h post dose.

To evaluate the training effects of whole body vibration (WBV) combined with weighted vest (WV) in older adults.
This randomized controlled trial study was conducted in healthy older adults living in the community. Fifty-one participants were randomly allocated into 3 groups: group 1 (n = 17), WBV alone, training on WBV at a frequency 30 Hz, amplitude 2 mm, 10 sets of 1 min squats, with 60 s rest, group 2 (n = 15), WV alone, squat exercise, 10 sets of 1 min, with 60 s rest, while WV loaded with 10% body weight and group 3 (n = 19), WBV + WV, combining WBV exercise with the addition of a WV. All groups completed training 3 times per week for 8 weeks. The outcomes were total muscle mass, muscle thickness, maximal isometric strength, single-leg-stance and timed-up-and-go evaluated at baseline and after training.
As a result of training all groups improved their isometric muscle strength with little difference between groups. The single-leg-stance significantly improved only in WBV + WV group 25.1 ± 10.8 s (mean ± 95% CI, p < 0.01). The timed-up-and-go improved in all groups, but the improvement was significantly greater in the WBV + WV group (17.5 ± 6.9%) compared to the WV (8.5 ± 3.2%) and WBV groups (9.2 ± 5.4%, p = 0.043, 0.023 respectively). Rectus femoris muscle thickness and total muscle mass were significantly increased in all groups equally with little difference between groups.
The combined WBV + WV had a greater effect on the single-leg-stance and the timed-up-and-go compared to WV or WBV alone.
TCTR20190306001. Thai Clinical Trials Registry ( www.thaiclinicaltrials.org ). Date of registration: 6 March 2019.

Heart rate (HR) and heart rate variability (HRV) based physiological metrics such as Excess Post-exercise Oxygen Consumption (EPOC), Energy Expenditure (EE), and Training Impulse (TRIMP) are widely utilized in coaching to monitor and optimize an athlete\'s training load. Chest straps, and recently also dry electrodes integrated to special sports vests, are used to monitor HR during sports. Mechanical design, placement of electrodes, and ergonomics of the sensor affect the measured signal quality and artefacts. To evaluate the impact of the sensor mechanical design on the accuracy of the HR/HRV and further on to estimation of EPOC, EE, and TRIMP, we recorded HR and HRV from a chest strap and a vest with the same ECG sensor during supervised exercise protocol. A 3-lead clinical Holter ECG was used as a reference. Twenty-five healthy subjects (six females) participated. Mean absolute percentage error (MAPE) for HR was 0.76% with chest strap and 3.32% with vest. MAPE was 1.70% vs. 6.73% for EE, 0.38% vs. 8.99% for TRIMP and 3.90% vs. 54.15% for EPOC with chest strap and vest, respectively. Results suggest superior accuracy of chest strap over vest for HR and physiological metrics monitoring during sports.

BACKGROUND: The use of a \'do not interrupt\' vest during medication administration rounds is recommended but there have been no controlled randomized studies to evaluate its impact on reducing administration errors. We aimed to evaluate the impact of wearing such a vest on reducing such errors. The secondary objectives were to evaluate the types and potential clinical impact of errors, the association between errors and several risk factors (such as interruptions), and nurses\' experiences.
METHODS: This was a multicenter, cluster, controlled, randomized study (March-July 2017) in 29 adult units (4 hospitals). Data were collected by direct observation by trained observers. All nurses from selected units were informed. A \'Do not interrupt\' vest was implemented in all units of the experimental group. A poster was placed at the entrance of these units to inform patients and relatives. The main outcome was the administration error rate (number of Opportunities for Error (OE), calculated as one or more errors divided by the Total Opportunities for Error (TOE) and multiplied by 100).
RESULTS: We enrolled 178 nurses and 1346 patients during 383 medication rounds in 14 units in the experimental group and 15 units in the control group. During the intervention period, the administration error rates were 7.09% (188 OE with at least one error/2653 TOE) for the experimental group and 6.23% (210 OE with at least one error/3373 TOE) for the control group (p = 0.192). Identified risk factors (patient age, nurses\' experience, nurses\' workload, unit exposition, and interruption) were not associated with the error rate. The main error type observed for both groups was wrong dosage-form. Most errors had no clinical impact for the patient and the interruption rates were 15.04% for the experimental group and 20.75% for the control group.
CONCLUSIONS: The intervention vest had no impact on medication administration error or interruption rates. Further studies need to be performed taking into consideration the limitations of our study and other risk factors associated with other interventions, such as nurse\'s training and/or a barcode system.
BACKGROUND: The PERMIS study protocol (V2-1, 11/04/2017) was approved by institutional review boards and ethics committees (CPP Ile de France number 2016-A00211-50, CNIL 21/03/2017, CCTIRS 11/04/2016). It is registered at ClinicalTrials.gov (registration number: NCT03062852 , date of first registration: 23/02/2017).