The Cardiac Recovery Room: Robotics and Enhanced Recovery After Surgery

In this episode of The Cardiac Recovery Room, moderator Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center, USA, spoke with T. Sloane Guy, a cardiovascular surgeon at Georgia Heart Institute at Northeast Georgia Medical Center, and Chase Brown, Director of Robotic Coronary Surgery at the University of Pennsylvania, USA, about robotics and enhanced recovery after surgery (ERAS). Chapters  00:00 New Cardiac Surgery Indication  04:59 Training, Mentorship  08:54 Robotics & ERAS Synergy  12:47 Need for Less Invasiveness  17:26 Accessible Training Pathway  19:16 Surgeon Commitment  19:56 Technique Innovation  23:04 Perioperative Phase  They explore the growth of robotic systems, the increasing number of robotic systems gaining FDA approval, and resistance to the adoption of robotics. They also discussed training and learning robotics, the importance of mentorship, and what robotics adds to ERAS programs—and vice versa. Additionally, they examine nonrobotic endoscopic surgery, the challenges of establishing a robotic program, the importance of committing to robotics, and the advantages of robotic mitral valve surgery over minithoractomy. The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode featuring a leadership panel from the ERAS Cardiac Society is released.   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with David Waller, Chair of the EACTS Emphysema Taskforce and Director of the EACTS Fundamentals Course in Thoracic Surgery, about the EACTS expert consensus document on lung volume reduction for emphysema. Chapters 00:00 Intro 02:10 EACTS Technocollege 03:23 Robotic Cardiac Focus 07:34 EACTS Highlights 13:17 Influence of Stenosis on Patency 14:58 Repair vs Replace Degen MR 16:08 Drain Strategy & Outcomes 17:20 Postcardiotomy Cardiogenic Shock 19:11 Bilateral Lung Transplant 20:11 Bicuspid Valve-Sparing ARR 21:08 Neoadjuv Chemoimmunotherapy Podcast 22:04 Post-Intubation Tracheal Injury 22:32 Value of the Heart Team Interview 23:50 Dr. Waller, LVRS Guidelines 35:37 Virtual Career Fair 36:22 Oral Board AI Simulator 36:36 Resident Video Competition They discussed the task force responsible for developing the document, the potential benefits of the guidelines, and key topics addressed in the document, including patient selection and complications. They also explored the benefits of lung volume reduction for emphysema, screening programs, controversial areas of emphysema, and the importance of team decision-making. Joel also highlights recent JANS articles on influence of LAD-diagonal stenosis on long-term patency and ischemic events after CABG, mitral valve repair vs replacement for degenerative mitral regurgitation in patients with poor ejection fraction, contemporary chest drain practice after pulmonary resection, and ten guiding principles for the management of postcardiotomy cardiogenic shock. In addition, Joel explores a sequential bilateral lung transplant in situs inversus totalis and Kartagener syndrome, bicuspid valve-sparing aortic root replacement, surgical repair of a post-intubation tracheal injury, perspectives from Vincent Gaudiani and Chad Rammohan on the value of the heart team, and an episode of The Atrium podcast featuring host Alice Copperwheat speaking with Jessica Donington about neoadjuvant chemoimmunotherapy. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned Influence of LAD-Diagonal Stenosis on Long-Term Patency and Ischemic Events After CABG MVr vs Replacement for Degenerative MR in Patients With Poor Ejection Fraction Contemporary Chest Drain Practice After Pulmonary Resection Ten Guiding Principles for the Management of Postcardiotomy Cardiogenic Shock CTSNet Content Mentioned Sequential Bilateral Lung Transplant in Situs Inversus Totalis and Kartagener Syndrome Bicuspid Valve-Sparing Aortic Root Replacement The Atrium: Neoadjuvant Chemoimmunotherapy Surgical Repair of a Post-Intubation Tracheal Injury The Value of the Heart Team: Perspectives From Vincent Gaudiani and Chad Rammohan Other Items Mentioned EACTS Expert Consensus Document on Lung Volume Reduction for Emphysema Oral Board AI Simulator 2026 Virtual Career Fair Resident Video Competition Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, California, USA, speaks with Lakhmir Chawla, Assistant Clinical Professor (Voluntary) of Medicine at the University of California San Diego, USA, and Chief Medical Officer of ExThera Medical. Together, they discuss the science behind new therapies for vasoplegia and potential treatment algorithms to rapidly restore vascular tone and hemodynamic stability. Chapters  00:00 Intro  00:43 Clinical Challenge & Angiotensin II  15:41 Issue of Vasoplegia, Patient Example  22:15 Angiotensin II Protocol  25:56 Potential Concerns  27:52 Multi-Mode, Low Dose Approach  29:50 Patient Population  32:39 Key Takeaways  The discussion explores the history of angiotensin II, including how it emerged as a treatment for vasoplegia, the oxygen transport hypothesis, vasopressin dosing, dopamine and renal blood flow, and the benefits of angiotensin II. They also discuss a patient who underwent left ventricular assist device (LVAD) explantation followed by heart transplantation and how they would approach the patient to achieve positive outcomes. Additional topics include angiotensin II protocols, thromboembolic events, and potential studies involving this patient population. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don’t miss next month’s episode!   Related Resources Management Algorithm for Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Bart P. van Putte, a cardiothoracic surgeon at the St. Antonius Hospital in Nieuwegein, Netherlands, and the Amsterdam University Medical Center about the excimer laser assisted non-occlusive anastomosis (ELANA) system in coronary artery bypass grafting (CABG). Chapters 00:00 Intro 01:48 CMS NCD Webinar 02:20 Oral Board AI Simulator 02:57 Podcast Frequency Update 04:09 CTSNet at EACTS 2026 04:44 Bi vs Single IMA Grafting in CABG 06:40 Radial Artery vs Saph Vein Third Conduit 08:37 Right-Sided Min Inv OPCAB 10:17 Right Basilar Transplant w Carinal Reconstr 12:12 Lymph Node Dissection & Chylothorax Analysis 14:11 Type A AD Causing Hematoma & Compression 16:13 Robotic Extended Sympathectomy 17:27 Ross Procedure Child w Bicuspid AV 19:56 Dr. van Putte, ELANA System CABG 34:45 Career Center They discussed the purpose of the ELANA system, what it is, and how it works. They also reviewed the system’s critical procedural step and explored its potential application in jump grafts. Additionally, they analyzed the clinical cases in which the system was utilized, including the findings. They also outlined the next steps and evaluated the feasibility of implementing this system at other clinical centers. Joel also highlights recent JANS articles on midterm outcomes after bilateral vs single internal mammary artery grafting in minimally invasive direct coronary artery bypass, a comparison of radial artery and saphenous vein as the third conduit with bilateral internal mammary arteries in coronary bypass surgery, a case report on right basilar segmental autologous lung transplantation with carinal reconstruction in a patient with central lung squamous cell carcinoma, Type A aortic dissection causing pulmonary artery intramural hematoma and compression, and a Society of Thoracic Surgeons general thoracic surgery database analysis of the association between lymph node dissection and chylothorax. In addition, Joel explores a robotic extended sympathectomy for severe compensatory hyperhidrosis, right-sided minimally invasive off-pump coronary artery bypass, and the Ross procedure for infective endocarditis with extensive aortic root destruction in a child with a bicuspid aortic valve. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned Mid-Term Outcomes After Bilateral Versus Single Internal Mammary Artery Grafting in MIDCAB Comparison of RA and Saphenous Vein as the Third Conduit With BIMA in Coronary Bypass Surgery Right Basilar Segmental Autologous Lung Transplantation With Carinal Reconstruction for Central Lung SCC Type A Aortic Dissection Causing Pulmonary Artery Intramural Hematoma and Compression An STS General Thoracic Surgery Database Analysis of the Association Between LN Dissection and Chylothorax CTSNet Content Mentioned Robotic Extended Sympathectomy for Severe Compensatory Hyperhidrosis Right-Sided Minimally Invasive Off-Pump Coronary Artery Bypass Ross Procedure for Infective Endocarditis With Extensive Aortic Root Destruction in a Child With a Bicuspid Aortic Valve Other Items Mentioned The First Prospective Safety and Effectiveness Trial of the Excimer Laser Assisted Nonocclusive Anastomosis System in Coronary Artery Bypass Grafting Oral Board AI Simulator The TAVR Heart Team in 2026: Navigating the CMS Decision | A CTSNet Webinar Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of The Atrium, host Alice Copperwheat speaks with Jessica Donington, Professor of Surgery and Chief of the Section of Thoracic Surgery at the University of Chicago, Illinois, USA, about neoadjuvant chemoimmunotherapy. Chapters 00:00 Intro 01:20 Why CT Surgery? 04:16 History 06:55 Patient Perception 08:42 Function, Why? 12:40 Patient Selection, Who? 18:20 Resectability 25:31 Types of Neoadj Therapy, What? 30:06 Evidence 33:01 Surgeon Responsibility 39:02 Robotics 39:54 Post Op Considerations 41:29 Key Points 43:12 Surgical Training Advice The discussion emphasizes the importance of being upfront and honest during patient conversations. It explores the benefits of neoadjuvant chemoimmunotherapy, how patients are selected for these treatments, and the various clinical trials on this topic. The conversation also addresses the chemo-radiation route and the clinical assessment of resectability. They also examine how to determine if a tumor is resectable and what factors are assessed during this process. It also highlights the need to consider whether a planned lobectomy might necessitate a pneumonectomy following neoadjuvant chemoimmunotherapy. The conversation also covers chemotherapy, immunotherapy, and targeted therapy, outlining what trainees should remember about each. Finally, they address the complexities of neoadjuvant chemoimmunotherapy, key takeaways for trainees, and the importance of working closely with the entire multidisciplinary team throughout the process. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Keep an eye out for next month’s episode.     Disclosure Dr. Donington serves as an advisor, consultant, and speaker for AstraZeneca, BMS, Genentech/Roche, and Merck. Additionally, she acts as a consultant for Biodesix and an advisor for Lilly.     Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Traves Crabtree, Professor and Chair of the Division of Cardiothoracic Surgery and Medical Director of the Surgical Skills Laboratory at the Memorial Learning Center at Southern Illinois University School of Medicine in Springfield, Illinois, USA, about the Oral Board AI Simulator (OBAS) and the benefits it offers for board preparation. Chapters 00:00 Intro 02:01 CMS NCD on TAVR Heart Team 06:15 JANS 1, Ross Procedure Determinants 08:20 JANS 2, Supra-Annular Perceval Bentall 10:44 JANS 3, Simplified MV Edge-to-Edge 12:35 JANS 4, CT Findings Addition Donors 14:19 JANS 5, Auto Robotic Phlebotomy Device 16:32 Video 1, MVR After MitraClip 18:53 Video 2, VATS Resection 10-cm Mediast Mass 20:04 Video 3, Modified Trapdoor Technique ALCAPA 21:36 Dr. Crabtree, Oral Board AI Simulator 32:28 Upcoming Events They discussed the origin of the OBAS, its progress on CTSNet, and the feedback received thus far. The conversation also covered the current number of scenarios within OBAS, the importance of user feedback for the program’s expansion, and the future development of the simulator, which includes the integration of imaging and positive feedback mechanisms for participants. Joel also highlights recent JANS articles on determinants of long-term durability for the Ross procedure, supra-annular perceval Bentall, real-world outcomes after simplified mitral valve transcatheter edge-to-edge repair under sole transesophageal echocardiographic guidance, if the addition of computed tomography findings maintains the predictive performance of an existing radiograph-based donor lung acceptability score, and a multicenter trial on the performance, safety, and patient experience of an autonomous robotic phlebotomy device. In addition, Joel explores mitral valve repair after MitraClip, VATS resection of a 10-centimeter mediastinal mass with subxiphoid removal, and the modified trapdoor technique for direct reimplantation of ALCAPA. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned The Ross Procedure: Determinants of Long-Term Durability Supra-Annular Perceval Bentall: From Concept to Patient Real-World Outcomes After Simplified Mitral Valve Transcatheter Edge-to-Edge Repair Under Sole Transesophageal Echocardiographic Guidance The Addition of Computed Tomography (CT) Findings Maintains the Predictive Performance of an Existing Radiograph-Based Donor Lung Acceptability Score Performance, Safety, and Patient Experience of an Autonomous Robotic Phlebotomy Device: A Multicenter Trial CTSNet Content Mentioned Mitral Valve Repair After MitraClip VATS Resection of a 10-Centimeter Mediastinal Mass With Subxiphoid Removal Modified Trapdoor Technique for Direct Reimplantation of ALCAPA Other Items Mentioned Oral Board AI Simulator The TAVR Heart Team in 2026: Navigating the CMS Decision | A CTSNet Webinar CTSNet Innovation Video Competition Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of The Cardiac Recovery Room, moderator Subhasis Chatterjee, a cardiothoracic surgeon at Baylor College of Medicine, Houston Texas, USA, spoke with J. W. Awori Hayanga, Professor of Surgery at West Virginia University, Morgantown, West Virginia, USA, and Nicholas Teman, an Associate Professor of Surgery from the University of Colorado Anschutz, Boulder, Colorado, USA, about extracorporeal membrane oxygenation (ECMO). Chapters  00:00 Intro  01:18 ECMO Broad Picture  04:28 Deciding ECMO  07:32 Deciding Cannulation Configuration  10:13 Sedation De-Escalation  11:41 Patient Mobilization  15:34 Other ERAS Steps  18:00 VA ECMO  19:44 Closing Remarks  They explore the evolution of ECMO and its application for bridge-to-transplant and acute respiratory distress syndrome patients. The discussion examines criteria for ECMO candidacy and predicting which patients may need ECMO, cannulation, and body mass index (BMI). Furthermore, they detail strategies for sedation de-escalation, safe patient mobilization protocols, and best practices for center implementing ECMO mobilization. The conversation also addresses veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and preserving mobilization for VA-ECMO patients. The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode featuring a leadership panel from the ERAS Cardiac Society is released.   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with James Cox, Professor of Cardiac Surgery at the Feinberg School of Medicine at Northwestern Medicine in Chicago, Illinois, USA, and Patrick McCarthy, Executive Director of the Bluhm Cardiovascular Institute, Heller-Sacks Professor of Cardiothoracic Surgery, Professor of Cardiac Surgery at the Feinberg School of Medicine at Northwestern Medicine in Chicago, Illinois, USA, about the surgical treatment of atrial fibrillation (AF). Chapters  00:00 Intro  01:32 CMS NCD on TAVR Heart Team  04:22 JANS 1, Tarlatamab Clinical Responses   05:23 JANS 2, No Stent Hybrid Revasc Robotic TECAB  06:45 JANS 3, STS Risk Model for SAVR After TAVR  08:43 JANS 4, Surgical Exposure Bilat Lung Transplant  10:12 JANS 5, Heart Drug Failure Challenges Theory  12:53 Video 1, Off-Pump TECAB da Vinci 5  14:00 Video 2, Aortic Uncrossing, Circumflex Aorta  14:50 Video 3, Ross Face-Off, Twin Root Replacement  15:57 Dr. Cox & McCarthy, Atrial Fib Surgery  27:00 Upcoming Events  They discussed the vital importance of surgical treatment for AF, the current underutilization of these procedures, the rationale for why AF should be treated, and abating AF. Furthermore, they explored the role of AF as a quality marker, the necessity for surgeons to develop proficiency in these techniques, and the importance of resident training on this procedure. Additionally, they reviewed the benefits of devices for AF, examined arrythmias in general, and their newly published textbook on the subject. Joel also highlights recent JANS articles on the Society of Thoracic Surgeons risk model for surgical aortic valve replacement after transcatheter aortic valve replacement, a promising heart drug failing which challenged a long-held theory of disease, clinical responses to tarlatamab among patients with pulmonary carcinoid, hybrid revascularization with robotic totally endoscopic coronary bypass and stents, and the effect of surgical exposure on outcomes in bilateral lung transplantation. In addition, Joel explores off-pump totally endoscopic coronary artery bypass using the da Vinci 5, aortic uncrossing procedure for circumflex aorta, and a twin root replacement combined with coronary artery bypass after a previous Ross procedure. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned The Society of Thoracic Surgeons Risk Model for Surgical Aortic Valve Replacement After Transcatheter Aortic Valve Replacement A Promising Heart Drug Fails, Challenging a Long-Held Theory of Disease Clinical Responses to Tarlatamab Among Patients With Pulmonary Carcinoid Hybrid Revascularization With Robotic Totally Endoscopic Coronary Bypass and Stents: What Are the Outcomes When The Stent Does Not Happen? Effect of Surgical Exposure on Outcomes in Bilateral Lung Transplantation: Insight From the International Multicenter Extracorporeal Life Support in Lung Transplantation Registry CTSNet Content Mentioned Off-Pump Totally Endoscopic Coronary Artery Bypass Using the da Vinci 5: Closed-Chest Stabilizer Technique Aortic Uncrossing Procedure for Circumflex Aorta Ross “Face-Off”: Twin Root Replacement Other Items Mentioned Oral Board AI Simulator CTSNet Innovation Video Competition Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Taj Mohammed Fiyaz Chowdhry, a consultant thoracic surgeon at Burjeel Specialty Hospital, Sharjah, UAE, about uniportal robotics in the UAE. Chapters  00:00 Intro  01:02 TAVR Heart Team Decision Webinar  02:00 Oral Board AI Simulator  02:22 JANS 1, CABG MIST Randomized Trial  04:26 JANS 2, Tumor Mutational Burden Predictor  06:01 JANS 3, Dapagliflozin & Acute Kidney Injury  07:44 JANS 4, ECMO vs Mech Vent Lung Transplant  09:20 JANS 5, Right Pleuro-Pericardial Window  11:19 Video 1, MV De-Repair  12:41 Video 2, Upper Mini Pulm Art Banding  14:00 Dr. Chowdhry, UAE Uniportal Robotics  22:48 Upcoming Events  They discussed the advantages of uniportal approaches and uniportal robotics, advice for surgeons transitioning to uniportal robotics, and the differences in surgical practice between the UK and the UAE, such as insurance approval protocols. They also explored Dr. Chowdry’s experience introducing a new procedure to the UAE. Joel also highlights recent JANS articles on multivessel coronary artery bypass grafting via small thoracotomy versus sternotomy, a brief report on tumor mutational burden as a predictor of immune-related adverse events in patients with advanced non-small cell lung cancer receiving immune checkpoint inhibitors, a randomized clinical trial on dapagliflozin and acute kidney injury following cardiac surgery, extracorporeal membrane oxygenation versus mechanical ventilation as bridge to lung transplant, and right pleuro-pericardial window during cardiac surgery. In addition, Joel explores mitral valve de-repair, upper ministernotomy for pulmonary artery banding, and endoscopic septal tumor resection with biatrial reconstruction. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned Multivessel Coronary Artery Bypass Grafting via Small Thoracotomy Versus Sternotomy (MIST): An Investigator-Initiated, International, Open-Label, Randomised Controlled Trial Tumor Mutational Burden as a Predictor of Immune-Related Adverse Events in Patients With Advanced Non-Small Cell Lung Cancer Receiving Immune Checkpoint Inhibitors: A Brief Report Dapagliflozin and Acute Kidney Injury Following, Cardiac Surgery: A Randomized Clinical Trial Building Bridges: Extracorporeal Membrane Oxygenation Versus Mechanical Ventilation as Bridge to Lung Transplant—A Nationwide Analysis Right Pleuro-Pericardial Window During Cardiac Surgery: A Safe and Simple Technique That Decreases Postoperative Atrial Fibrillation CTSNet Content Mentioned Thinking Outside the Box: Mitral Valve De-Repair Upper Ministernotomy for Pulmonary Artery Banding: Facilitating Future Reentry Endoscopic Septal Tumor Resection With Biatrial Reconstruction Other Items Mentioned The TAVR Heart Team in 2026: Navigating the CMS Decision | CTSNet Webinar Oral Board AI Simulator CTSNet Innovation Video Competition Career Center CTSNet Events   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, California, USA, speaks with Sameh Said, Chief of the Division of Pediatric and Adult Congenital Cardiac Surgery at Maria Fareri Children’s Hospital in Valhalla, New York, USA. Together, they discuss the science behind new therapies for vasoplegia and potential treatment algorithms to rapidly restore vascular tone and hemodynamic stability. Chapters 00:00 Growing Patient Population 03:06 Diverse, Complex Anatomy 04:53 Adult Cardiac Problems 08:13 Case Study 1, Assessment 14:11 Reaching One Diagnosis 18:03 Blood Gas Management 21:51 Ventilator Management 25:18 Case Study 2, Assessment 30:39 Assessing Shunt, Defect 32:28 Pulmonary Circulation Concerns 37:13 Fundamentals & Takeaways The discussion explores the challenges of managing adults with congenital heart disease and its unique clinical considerations. It features two detailed case studies. The first examines a patient with tetralogy of Fallot, focusing on Dr. Said’s approach to managing a patient with a complex surgical history. Key topics include right ventricular function, the selection of appropriate inotropes, strategies for ventilator and blood gas management. The second case involves a 56-year-old patient with a history ventricular septal defect (VSD) patch repair and a moderate left-to-right shunt. This analysis covers methods for quantifying the magnitude and determining the direction of the shunt. Dr. Said concludes with clinical advice, emphasizing the importance of teamwork, establishing a thorough understanding of the patient’s baseline, and maintaining composure in complex clinical scenarios. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don’t miss next month’s episode and stay tuned for part 2!   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.