bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Outcomes in Critically Ill Septic Patients Who Survived Cardiopulmonary Resuscitation*
Authors: Chao Pei-Wen , Chu Hsi , Chen Yung-Tai , Shih Yu-Ning , Kuo Shu-Chen , Li Szu-Yuan , Ou Shuo-Ming , Shih Chia-Jen
Published: January 2016

Objective:

To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale.

Design

Retrospective and observational cohort study.

Setting

Data were extracted from Taiwan’s National Health Insurance Research Database.

Patients

A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled. Post-discharge survival outcomes of ICU sepsis survivors who received cardiopulmonary resuscitation were compared with those of patients who did not experience cardiopulmonary arrest using propensity score matching with a 1:1 ratio.

Intervention

None.

Measurements and Main Results:

Only 7% (n = 3,207) of sepsis patients who received cardiopulmonary resuscitation survived to discharge. The overall 1-, 2-, and 5-year postdischarge survival rates following cardiopulmonary resuscitation were 28%, 23%, and 14%, respectively. Compared with sepsis survivors without cardiopulmonary arrest, sepsis survivors who received cardiopulmonary resuscitation had a greater risk of all-cause mortality after discharge (hazard ratio, 1.38; 95% CI, 1.34–1.46). This difference in mortality risk diminished after 2 years (hazard ratio, 1.11; 95% CI, 0.96–1.28). Multivariable analysis showed that independent risk factors for long-term mortality following cardiopulmonary resuscitation were male sex, older age, receipt of care in a nonmedical center, higher Charlson Comorbidity Index score, chronic kidney disease, cancer, respiratory infection, vasoactive agent use, and receipt of renal replacement therapy during ICU stay.

Conclusion:

The long-term outcome was worse in ICU survivors of sepsis who received in-hospital cardiopulmonary resuscitation than in those who did not, but this increased risk of mortality diminished at 2 years after discharge.
Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation*
Authors: Yadav Hemang , Nolan Matthew E. , Bohman John K. , Cartin-Ceba Rodrigo , Peters Steve G. , Hogan William J. , Gajic Ognjen , Kor Daryl J.
Published: January 2016

Objectives:

Pulmonary complications are common following hematopoietic stem cell transplantation. Numerous idiopathic post-transplantation pulmonary syndromes have been described. Patients at the severe end of this spectrum may present with hypoxemic respiratory failure and pulmonary infiltrates, meeting criteria for acute respiratory distress syndrome. The incidence and outcomes of acute respiratory distress syndrome in this setting are poorly characterized.

Design:

Retrospective cohort study.

Setting:

Mayo Clinic, Rochester, MN.

Patients:

Patients undergoing autologous and allogeneic hematopoietic stem cell transplantation between January 1, 2005, and December 31, 2012.

Interventions:

None.

Measurements and Main Results:

Patients were screened for acute respiratory distress syndrome development within 1 year of hematopoietic stem cell transplantation. Acute respiratory distress syndrome adjudication was performed in accordance with the 2012 Berlin criteria. In total, 133 cases of acute respiratory distress syndrome developed in 2,635 patients undergoing hematopoietic stem cell transplantation (5.0%). Acute respiratory distress syndrome developed in 75 patients (15.6%) undergoing allogeneic hematopoietic stem cell transplantation and 58 patients (2.7%) undergoing autologous hematopoietic stem cell transplantation. Median time to acute respiratory distress syndrome development was 55.4 days (interquartile range, 15.1–139 d) in allogeneic hematopoietic stem cell transplantation and 14.2 days (interquartile range, 10.5–124 d) in autologous hematopoietic stem cell transplantation. Twenty-eight-day mortality was 46.6%. At 12 months following hematopoietic stem cell transplantation, 89 patients (66.9%) who developed acute respiratory distress syndrome had died. Only 7 of 133 acute respiratory distress syndrome cases met criteria for engraftment syndrome and 15 for diffuse alveolar hemorrhage.

Conclusions:

Acute respiratory distress syndrome is a frequent complication following hematopoietic stem cell transplantation, dramatically influencing patient-important outcomes. Most cases of acute respiratory distress syndrome following hematopoietic stem cell transplantation do not meet criteria for a more specific post-transplantation pulmonary syndrome. These findings highlight the need to better understand the risk factors underlying acute respiratory distress syndrome in this population, thereby facilitating the development of effective prevention strategies.
Intracardiac Right-to-Left Shunt Impeding Liberation From Veno-Venous Extracorporeal Membrane Oxygenation: Two Case Studies
Authors: Gillon Stuart A. , Barrett Nicholas A. , Ioannou Nicholas , Camporota Luigi , Victor Kelly , Gowland Abigail , Meadows Christopher I. S. , Langrish Christopher , Tricklebank Stephen , Wyncoll Duncan
Published: January 2016

Objectives:

Veno-venous extracorporeal membrane oxygenation is an increasingly used form of advanced respiratory support, but its effects on the physiology of the right heart are incompletely understood. We seek to illustrate the impact of veno-venous extracorporeal membrane oxygenation return blood flow upon the right atrium by considering the physiologic effects during interatrial shunting.

Patients:

Two veno-venous extracorporeal membrane oxygenation patients in whom an extracorporeal membrane oxygenation induced right-to-left interatrial shunt appears to have created a barrier to liberation from extracorporeal support.

Conclusions:

Veno-venous extracorporeal membrane oxygenation return flow generates a high-pressure jet that has potential to exert focal pressure upon the intra-atrial septum. In patients with potential for interatrial flow, this may lead to a right-to-left shunt, which becomes physiologically apparent only when sweep gas flow is ceased.
Impact of Widespread Cervical Cancer Screening
Authors: Yang Daniel X. , Soulos Pamela R. , Davis Brigette , Gross Cary P. , Yu James B.
Published: January 2016

Objectives:

With recent approval of standalone HPV testing and increasing uptake of HPV vaccination, some have postulated that we are moving toward a “post-Pap” era of cervical cancer prevention. However, the total number cases that have been prevented by Pap smear screening as well as its impact on racial disparities are unknown.

Methods:

We estimated national cervical cancer incidence from 1976 to 2009 using the Surveillance, Epidemiology, and End Result database. Screening data were obtained from the literature and National Cancer Institute Progress Reports. We examined early, late, and race-specific trends in cancer incidence, and calculated the estimated number of cancers prevented over the past 3 decades.

Results:

From 1976 to 2009, there was a significant decrease in the incidence of early-stage cervical cancer, from 9.8 to 4.9 cases per 100,000 women (P<0.001). Late-stage disease incidence also decreased, from 5.3 to 3.7 cases per 100,000 women (P<0.001). The incidence among black women decreased from 26.9 to 9.7 cases per 100,000 women (P<0.001), a greater decline compared with that of white women and women of other races. After adjusting for “prescreening era” rates of cervical cancer, we estimate that Pap smears were associated with a reduction of between 105,000 and 492,000 cases of cervical cancer over the past 3 decades in the United States.

Conclusions:

A large number of early-stage and late-stage cervical cancers were prevented and racial disparity in cancer rates were reduced during an era of widespread Pap smear screening.
Late Effects After Radiotherapy for Childhood Low-grade Glioma
Authors: Williams Noelle L. , Rotondo Ronny L. , Bradley Julie A. , Pincus David W. , Fort John A. , Wynn Tung , Morris Christopher G. , Mendenhall Nancy P. , Indelicato Daniel J.
Published: January 2016

Objectives:

This single-institution report describes long-term disease control and late effects in pediatric patients with low-grade glioma (LGG) following radiotherapy (RT).

Materials and Methods:

Twenty-nine pediatric patients with LGG were treated with photon-based RT from 1970 to 2004 (mean age at time of RT, 9.8 y; range, 0.6 to 19 y). One patient underwent gross total resection, 25 underwent subtotal resection or biopsy, and 3 were treated based on radiographic characteristics alone. Three patients underwent chemotherapy before RT. The median RT dose was 54 Gy (range, 40 to 55 Gy).

Results:

The median follow-up was 17.8 years (range, 1.6 to 36.8 y) for all patients and 19.9 years (range, 1.6 to 36.8 y) for all living patients. The 5-, 10-, and 20-year local control and progression-free survival rates were equivalent at 82%, 74%, and 63%, respectively. The 5-, 10-, and 20-year cause-specific survival and overall survival rates were equivalent at 89%, 85%, and 58%, respectively. On univariate analysis, age below 4 years during treatment was associated with significantly inferior local control (P=0.0067), cause-specific survival (P=0.0021), and overall survival (P=0.0021). Of the 23 survivors analyzed for late toxicity, 15 (65%) developed grade 3+ toxicity. The most common Common Terminology Criteria for Adverse Events grade 3 toxicity (30% of survivors) was serious cognitive disability. Four patients (14%) died secondary to treatment complications, all occurring over a decade after completing RT.

Conclusions:

Over half of children diagnosed with LGG survive >20 years after RT; this report reveals the chronicity of toxicity beyond the typically reported follow-up. Our findings inform the therapeutic ratio of RT in this disease and may help guide late-effect screening recommendations.
Smoking Decreases Survival in Locally Advanced Cervical Cancer Treated With Radiation
Authors: Mayadev Jyoti , Lim Jihoon , Durbin-Johnson Blythe , Valicenti Richard , Alvarez Edwin
Published: January 2016

Purpose:

To study the prevalence and effect of smoking on cervical cancer recurrence and mortality in patients undergoing definitive treatment with radiation.

Materials and Methods:

Between July 2007 and September 2013, 96 locally advanced cervical cancer patients received definitive radiation or chemoradiation followed by brachytherapy. Smoking status was obtained from prospective intake questionnaires and quantified by pack-years. Pelvic control (PC), disease-free survival (DFS), and overall survival (OS) were analyzed by multivariable Cox proportional hazards models.

Results:

Smoking history included 51 (53.1%) nonsmokers, 45 active smokers, and former smokers: 20 (20.8%) with 1 to 20 pack-years and 25 (26%) with 21+ pack-years. With a median follow-up of 2 years on univariate analysis, the impact of 1 to 20 pack-years on PC, DFS, and OS relative to nonsmokers was hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.36-14.1; P=0.014), 4.99 (95% CI, 1.21-22.4; P=0.027), and 4.77 (95% CI, 1.34-17.8; P=0.017), respectively. For patients with 21+ pack-years, the impact on PC, DFS, and OS was HR=6.13 (95% CI, 2.29-18.6; P<0.001), 7.24 (95% CI, 2.28-29.1; P=0.001), and 4.21 (95% CI, 1.26-15.4; P=0.02). On multivariate analysis, there remained a significant difference of 1 to 20 pack-years smoking history on OS relative to nonsmokers, HR=4.68 (95% CI, 1.02-29; P=0.047). For patients with 21+ pack-years smoking history, there continued to be a negative impact on PC and DFS, HR=5.66 (95% CI, 1.7-22.18; P=0.004) and HR=6.89 (95% CI, 1.54-42; P=0.011), respectively.

Conclusions:

Former and active tobacco smoking during radiation therapy for cervical cancer is associated with unfavorable PC, DFS, and OS outcomes. The increased number of smoking pack-years conferred a worse outcome effect in those treated with radiation.
OCULAR INVOLVEMENT IN HEMOPHAGOCYTIC SYNDROME: A NOVEL FUNDUSCOPIC MANIFESTATION AND REVIEW OF THE LITERATURE
Authors: Suhr Kristin S. , Chiang Michael F. , Flynn John T. , Engelbert Michael
Published: January 2016

Purpose:

Hemophagocytic syndrome (HS) is a rare disease with a spectrum of ocular findings. The authors report a unique funduscopic presentation of HS in a neonate and a discussion of diagnosis, typical features, management, and outcome.

Methods:

Single case report with retrospective analysis of the published literature of patients with HS and ocular findings from 1950 to present using the key terms hemophagocytic, lymphohistiocytosis, ocular, and ophthalmic. Literature search from 1950 to the present was performed through PubMed/MEDLINE and the Cochrane database. Requirement for inclusion was that the article or abstract was written in English.

Results:

A 4-week-old neonate with HS demonstrated bilateral discrete white dots within the retina, which resolved incompletely over the course of the next months but showed increased pigmentation.

Conclusion:

With so few documented ophthalmic cases of HS in existence, the ocular findings at this point can be seen as diverse and variable. However as more cases are reported, hopefully this will allow for increased recognition of the ophthalmic manifestations and sequelae and in turn lead to improved treatment of this disease.
SPONTANEOUS REGRESSION OF SEROUS RETINAL DETACHMENT ASSOCIATED WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA AFTER CHILDBIRTH
Authors: Sayman Muslubas Isil , Arf Serra , Hocaoglu Mumin , Ozdemir Hakan , Karacorlu Murat
Published: January 2016

Purpose:

To report a case of circumscribed choroidal hemangioma complicated by retinal detachment and regressed spontaneously after childbirth.

Methods:

Clinical examination, fundus photography, spectral domain optical coherence tomography with enhanced depth imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and microperimetry.

Results:

A 41-year-old woman was referred with a 2-week history of decreased vision and scotoma in the left eye. She was in her sixth month of pregnancy. Fundus examination revealed a circumscribed choroidal hemangioma appearing as a solitary orange-red mass in the upper peripapillary area and neurosensory retinal detachment of the macula. After the birth, spontaneous regression of the retinal detachment was observed.

Conclusion:

Pregnancy may cause exacerbation of choroidal hemangioma, and regression of the exudation may occur spontaneously after delivery. Treatment is not indicated when symptoms or signs of exudation disappear.
Improved Vision and Contact Lens Wear Time With Piggy-Back Contact Lens Systems in Children After Penetrating Corneal Trauma
Authors: Cromelin Caroline , Russell Buddy , Lambert Scott R.
Published: January 2016

Objective:

Consecutive case series of children treated successfully with “piggy-back” (PB) contact lens systems after corneal trauma.

Methods:

We reviewed the medical record of all children ages 4 to 14 years treated at the Emory Eye Center between January 11, 2003 and January 11, 2013 with PB contact lens systems.

Results:

Four children with a history of corneal penetrating trauma were treated with a PB lens system, with a mean age of 7±0.08 (range: 6–8) years. Best-corrected spectacle vision was count fingers in two children and logMAR +0.70 (Snellen equivalent 20/100) and logMAR +0.6 (Snellen equivalent 20/80) in the remaining two. The PB lens system was introduced with a mean of 15.7±6.5 (range: 9–22) months after the injury. All patients were initially fitted with gas-permeable (GP) lenses. Each child achieved 11 or more hours of daily contact lens wear time in PB systems. The mean best-corrected logMAR visual acuity using the PB system was 0.26±0.21 (Snellen equivalent 20/36). The mean improvement in best-corrected logMAR between GP and PB lens systems was +0.21±0.11, which corresponds to an improvement of greater than two lines on the Snellen chart.

Conclusion:

Piggy-back contact lens systems can be helpful to improve vision and contact lens wearing time in children with irregular astigmatism after corneal trauma, who are intolerant of GP contact lenses.
Changes in Peripheral Refraction, Higher-Order Aberrations, and Accommodative Lag With a Radial Refractive Gradient Contact Lens in Young Myopes
Authors: Pauné Jaume , Thivent Solène , Armengol Jesús , Quevedo Lluisa , Faria-Ribeiro Miguel , González-Méijome José M.
Published: January 2016

Purpose:

To evaluate changes in the peripheral refraction (PR), visual quality, and accommodative lag with a novel soft radial refractive gradient (SRRG) experimental contact lens that produces peripheral myopic defocus.

Methods:

59 myopic right eyes were fitted with the lens. The PR was measured up to 30° in the nasal and temporal horizontal visual fields and compared with values obtained without the lens. The accommodative lag was measured monocularly using the distance-induced condition method at 40 cm, and the higher-order aberrations (HOAs) of the entire eye were obtained for 3- and 5-mm pupils by aberrometry. Visual performance was assessed through contrast sensitivity function (CSF).

Results:

With the lens, the relative PR became significantly less hyperopic from 30° to 15° temporally and 30° nasally in the M and J0 refractive components (P<0.05). Cylinder foci showed significant myopization from 30° to 15° temporally and 30° to 25° nasally (P<0.05). The HOAs increased significantly, the CSF decreased slightly but reached statistical significance for 6 and 12 cycles per degree (P<0.05), and the accommodative lag decreased significantly with the SRRG lens (P=0.0001). There was a moderate correlation between HOAs and CSF at medium and high spatial frequencies.

Conclusion:

The SRRG lens induced a significant change in PR, particularly in the temporal retina. Tangential and sagittal foci changed significantly in the peripheral nasal and temporal retina. The decreased accommodative lag and increased HOAs particularly in coma-like aberration may positively affect myopia control. A longitudinal study is needed to confirm this potential.
Contact Lens–Induced Discomfort and Inflammatory Mediator Changes in Tears
Authors: Masoudi Simin , Zhao Zhenjun , Stapleton Fiona , Willcox Mark
Published: January 2016

Purpose:

Studies indicate that contact lens (CL) discontinuation mostly occurs because of dryness and discomfort symptoms. This study aimed to investigate relationships between changes in the concentration of tear inflammatory mediators with subjective comfort ratings with CL wear and no contact lens wear between morning and evening.

Method:

Forty-five subjects collected tears twice daily in the morning and in the evening with or without lenses. Comfort was rated subjectively on a scale from 1 to 100 (where 100 was extremely comfortable) just before each tear collection. Tear samples were assayed for complement components (C3 and C3a), leukotriene B4 (LTB4), secretory phospholipase A2 (sPLA2), secretory immunoglobulin A (sIgA), and bradykinin using commercially available immuno-based assay kits.

Results:

Comfort ratings showed a statistically significant decline from morning to evening both with CL (89.0±10.1 am vs. 76.7±15.2 pm; P<0.001) and without CL (89.1±10.2 am vs. 84.2±12.6 pm; P<0.005) wear. The decline was steeper with lens wear (P<0.001). Bradykinin and sPLA2 levels did not change between morning and evening or with CL wear (P>0.05). Leukotriene B4 levels were slightly higher in CL (CL 43.4±12.6 pg/ml vs. No CL 39.4±13.4 pg/mL; P=0.034), whereas the concentration of LTB4, C3, C3a, and sIgA dropped by the end of the day in the presence or absence of lens wear (P<0.001). For most mediators, tear levels were not correlated with comfort ratings in any of the conditions. Leukotriene B4 had a higher concentration in the evening, and when measured as a ratio to sIgA, there was a trend for increased concentration of this mediator during CL wear.

Conclusion:

Although specific mediators showed changes from morning to evening with and without lens wear, most of these were not correlated with subjective comfort ratings in lens wear. The only mediator that showed an increase in concentration during the day and during lens wear was LTB4, and further studies on this mediator are warranted.
Comparative Evaluation of Use of 400-μm and 350-μm Microkeratome Head to Prepare Donor Tissue in Cases of Descemet Stripping Automated Endothelial Keratoplasty
Authors: Jain Srheyans , Sharma Namrata , Maharana Prafulla K. , Agarwal Tushar , Sinha Rajesh , Vajpayee Rasik B.
Published: January 2016

Purpose:

To compare the outcomes of 400-μm microkeratome head with 350-μm microkeratome head Descemet stripping automated endothelial keratoplasty (DSAEK) in a prospective comparative study.

Methods:

Twenty cases of pseudophakic bullous keratopathy were randomly allocated into two groups. Group 1 underwent slow, single-pass 400-μm microkeratome head, whereas group 2 underwent the standard technique of DSAEK using a 350-μm microkeratome head. The primary outcome measures were best-corrected visual acuity (BCVA) at 6 months.

Results:

Groups were comparable in baseline characteristics. The mean central graft thickness (GT) at 6 months in group 1 was significantly thinner than group 2 (90.44±28.67 vs. 165.60±62.74 μm; P=0.003). The BCVA and contrast sensitivity were significantly better in group 1 than in group 2 (BCVA: 0.34±0.15 vs. 0.53±0.19 logMAR units, P=0.02; contrast sensitivity: 1.48±0.13 vs. 1.06±0.22, P=0.001). A significant correlation was found between both postoperative BCVA and contrast sensitivity, with the postoperative GT using Spearman rho correlation analysis (R=0.534, P=0.01 for BCVA and R=−0.522, P=0.02 for contrast sensitivity). The percentage endothelial cell loss was comparable between the 2 groups at the last follow-up (P=0.3). No major complications were observed during the study period.

Conclusions:

The use of a 400-μm microkeratome head instead of 350-μm head can improve the visual outcomes in DSAEK without increasing the risk of complications. The thickness of the DSAEK graft can affect the visual acuity and contrast sensitivity.
The Mechanics of Brow-Suspension Ptosis Repair: A Comparative Study of Fox Pentagon and Crawford Triangle Techniques
Authors: Kwon Kyung-Ah , Shipley Rebecca J. , Edirisinghe Mohan , Best Serena M. , Cameron Ruth E. , Poitelea Cornelia , Rose Geoffrey E. , Ezra Daniel G.
Published: January 2016

Purpose:

To perform quantitative analysis of the most commonly used brow-suspension configurations.

Methods:

The inflection positions for Fox pentagon and Crawford triangle configurations were marked on 49 healthy volunteers (male and female) and photographs taken in 3 states: “normal,” “closed,” and “raised.” The skin marks were measured vectorially with respect to the medial canthus, and displacement changes were evaluated for “normal-to-closed” (“blinking”) and from “closed-to-raised” (“eye-opening”) states. The distance between a pair of inflection marks, representing the approximate path of sling configurations, were also measured and analyzed in relation to the mechanical properties of a variety of synthetic brow-suspension materials.

Results:

“Blinking” resulted in the greatest displacement in the medial eyelid incision, resulting in the greatest strain on the line connecting the medial eyelid and medial brow inflections. No significant differences in the strains for individual lines were found between the Fox and Crawford techniques, although the former shows a significantly lower overall strain in the whole loop than the latter. The displacements of some inflections and of the strains of a few lines differed significantly in men and women.

Conclusions:

Within the scope of this study, the blinking action was shown to result in the maximum strain of ~40%, which lies within the elastic region of stress–strain curves for some commonly used synthetic brow-suspension materials. No one method was statistically superior, although the Fox pentagon gave a significantly lower overall strain when the sling material was assumed to move somewhat around the inflections within a closed loop.
Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction
Authors: Davies Michael J. , Dolman Peter J.
Published: January 2016

Purpose:

To identify levator palpebrae superioris enlargement in thyroid eye disease (TED)-related upper eyelid retraction (ULR).

Methods:

Retrospective case–control. Subjects included 50 consecutive patients with unilateral thyroid eye disease-related ULR ≥ 2 mm and no previous eyelid surgery. The contralateral side was used as control. Clinical information was recorded from charts. CT scans were assessed by investigators blinded to the clinical data. A prediction of retracted side was made based on CT scan appearance and on basis of measured levator palpebrae superioris cross-sectional area at 2 defined points. Statistical analysis determined correlation between levator palpebrae superioris size and presence of ULR. The study was approved by the institutional ethics committee.

Results:

Side with ULR predicted from CT scan review in over 85% of cases. Mean cross-sectional area of levator palpebrae superioris on retracted side was significantly larger than nonretracted side at 2 separate sites. Levator palpebrae superioris area was larger on retracted side compared with nonretracted side in over 85% of subjects. More than 30% of subjects had no enlargement of other extraocular muscles. Only 6% of patients had enlargement of the ipsilateral inferior rectus muscle.

Conclusions:

Levator palpebrae superioris enlargement from inflammation or scar is a factor in thyroid eye disease-related ULR. Upper eyelid retraction can be predicted from CT scan appearance in over 85% of cases. Ipsilateral inferior rectus enlargement is rare. Levator palpebrae superioris is the most commonly targeted muscle in thyroid eye disease.
Central Retinal Vein Occlusion Resolving After Orbital Decompression in Thyroid Eye Disease
Authors: Grob Seanna R. , Yoon Michael K.
Published: January 2016

A 49-year-old male presented with proptosis and was found to have optic nerve edema with peripapillary hemorrhages. Diagnostic testing showed a suppressed thyroid-stimulating hormone. CT orbits showed homogenous tendon-sparing enlargement of the medial and inferior rectus muscles, characteristic of thyroid eye disease. Intravenous methylprednisolone was administered given the concern for compressive optic neuropathy. He initially had improvement of his symptoms, so orbital decompression was deferred. Subsequently he presented with worsening diplopia and right proptosis, a new afferent pupillary defect, and a cecocentral visual field defect. Dilated examination revealed significant optic nerve head edema and diffuse retinal hemorrhages in all 4 quadrants consistent with a central retinal vein occlusion. The patient underwent an urgent 3-wall orbital decompression on the right. Close follow up postoperatively showed resolution of the central retinal vein occlusion and the associated optic disc edema, peripapillary hemorrhages, and macular edema. Orbital decompression is known to improve many manifestations of thyroid eye disease, but this is the first report of orbital decompression resulting in resolution of a central retinal vein occlusion.
Acinetobacter ursingii Bacteremia From a Peripherally Inserted Central Catheter in a Woman With Hyperemesis Gravidarum
Authors: Holloman Conisha , Franco Arielle , Carlan Stephen J. , Busowski Mary , Busowski John
Published: January 2016

Background

Hyperemesis gravidarum is defined as severe nausea and vomiting of pregnancy associated with weight loss and dehydration if left untreated. Treatment will sometimes require the placement of a peripherally inserted central catheter line for the administration of intravenous antiemetics, total parenteral nutrition, and rehydration. Acinetobacter ursingii is a nonmotile, aerobic, gram-negative coccobacilli that are widespread in natural moist environments and are rarely isolated as a definitive human pathogen.

Case

We present a case of a previously healthy immunocompetent pregnant woman in the second trimester with a peripherally inserted central catheter line placed for the management of hyperemesis gravidarum who subsequently developed bacteremia with A. ursingii. The patient was treated with intravenous meropenem and oral ciprofloxacin.

Conclusions

Central catheters are a risk factor for sepsis with A. ursingii in immunocompetent pregnant women, and aggressive treatment with appropriate antibiotics should be implemented.
Initial Therapy for Mild to Moderate Clostridium difficile Infection
Authors: Siegfried Justin , Dubrovskaya Yanina , Flagiello Thomas , Scipione Marco R. , Phillips Michael , Papadopoulos John , Chen Donald , Safdar Amar
Published: January 2016

Background

Oral vancomycin is being increasingly used for treatment of Clostridium difficile infection (CDI), although the feasibility for such approach and avoidance of currently recommended oral metronidazole for mild to moderate (mm)-CDI remain uncertain. We sought to assess treatment response in hospitalized patients with mm-CDI at our university medical center.

Methods

Standard Infectious Diseases Society of America and Society for Healthcare Epidemiology of America definitions were used. Primary outcomes included rate of treatment response and infection recurrence following therapy.

Results

Among 513 total cases of CDI between 2011 and 2013, 168 were mm-CDI and were further analyzed. Overall treatment responses to oral vancomycin were 97% versus 82% in patients given metronidazole (P = 0.002). Overall rate of CDI recurrence was 13% following vancomycin versus 9% following metronidazole treatment (P = 0.4). In 85 patients with NAP1 (North American PFGE type 1) CDI, vancomycin and metronidazole yielded similar response (97% vs 98%, P = 0.13), whereas in 83 patients with non-NAP1 CDI, rate of treatment response to vancomycin was higher (98% vs 78% with metronidazole, P = 0.007). In a regression analysis, initial therapy with metronidazole was an independent predictor of treatment failure (odds ratio, 8.4; 95% confidence interval, 1.75–40; P = 0.007) after controlling for hypoalbuminemia (<3 g/dL), concurrent use of proton pump inhibitors, chronic liver disease, community-onset CDI, age older than 65 years, and presence of more than 3 comorbidities. In the subset of 91 patients treated with metronidazole, presence of chronic liver disease (odds ratio, 4.4; 95% confidence interval, 1.19–16.4; P = 0.027) was associated with treatment failure.

Conclusions

Oral metronidazole therapy for mm-CDI in hospitalized patients might not be optimal and needs further reassessment.
Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data
Authors: Quader Mohammed , LaPar Damien J. , Wolfe Luke , Ailawadi Gorav , Rich Jeffrey , Speir Alan , Fonner Clifford , Kasirajan Vigneshwar
Published: January 2016

Blood transfusion rates with cardiac surgery over time have decreased, this trend has not been examined for patients undergoing left ventricular assist device (LVAD) implantation. We investigated blood transfusion trends with LVAD implantation in a statewide database. Between July 2004 and June 2014, 666 LVADs were implanted (age 54.5 ± 12.6 years. 77% men). Reoperation for bleeding was required in 22% of cases. Postoperative mortality was 13.2%. Over the decade, use of any blood products with LVAD surgery by year ranged from 83% to 100% (92 ± 5.3%). Intraoperative and postoperative blood products use was 71.8% and 73%, respectively. Only 7.4% of patients did not receive any blood products. Blood transfusion during surgery consisted of plasma (60%), platelets (56%), red blood cells (RBCs) (44.3%), and cryoprecipitate (32%), whereas after surgery RBC use was more frequent (68%). Compared with the initial 5 years (2005–2009), the units of blood transfused in the second 5 years (2010–2014) were significantly less, 21 ± 23 units vs. 16.6 ± 20.5 units,p= 0.0038. By multivariable analysis, preoperative factors predictive of blood transfusion are lower hematocrit, lower BMI, reoperative surgery, requirement for intraaortic balloon pump (IABP), and nonelective surgery. Blood transfusion with LVAD implantation remains very high. However, the amount of blood product transfused has decreased in the last 5 years.
Driveline Infection Risk with Utilization of a Temporary External Anchoring Suture After Implantation of a Left Ventricular Assist Device
Authors: Fudim Marat , Brown Christopher L. , Davis Mary E. , Djunaidi Monica , Danter Matthew R. , Harrell Frank E. , Stulak John M. , Haglund Nicholas A. , Maltais Simon
Published: January 2016

Driveline infections (DLI) are a cause of morbidity after continuous-flow left ventricular assist device (CF-LVAD) implantation. Because driveline trauma contributes to DLI, we assessed whether intraoperative placement of a temporary external anchoring suture (EAS) influenced DLI rate. We analyzed 161 consecutive patients with CF-LVAD (HMII 82; HW 79) implantation. Two groups were defined: placement of EAS (n = 85) or No EAS (n = 76). For NO EAS patients, the driveline was permanently anchored internally to the rectus fascia. Cox proportional analysis was performed to assess the effect of EAS on time to first confirmed DLI. Baseline characteristics were comparable between groups (all p = 0.3). Mean follow-up time was 0.93 years. A total of 18 (11.1%) patients developed confirmed culture positive DLI, with “first infection” rate of 0.13 events/year. Mean time to confirmed DLI was 0.69 years. Driveline infection was less likely (hazard ratio [HR] = 0.28, 0.95 confidence interval [CI] = 0.06–1.25, p = 0.056) to occur in NO EAS (2/18) then in EAS (16/18). Confirmed DLI was comparable between device types (p = 0.3). Multivariable regression adjusted for age, BMI, blood product use, device type, and diabetes showed equivocal effect of EAS (HR = 0.33, 0.95 CI = 0.07–1.54, p = 0.12). Patients with a temporary EAS may have an increased risk of confirmed DLI after device implantation.
Cardiopulmonary Bypass with Low- Versus High-Priming Volume: Comparison of Inflammatory Responses in a Rat Model
Authors: Fujii Yutaka , Shirai Mikiyasu , Takewa Yoshiaki , Tatsumi Eisuke
Published: January 2016

A cardiopulmonary bypass (CPB) can preserve life. However, interactions between blood and large artificial surfaces might help to provoke a series of chain reactions during CPB that result in the formation and release of numerous powerful inflammatory mediators including hormones and autacoids. We postulated that small CPB circuits with reduced priming volumes and less surface areas that come into contact with blood would attenuate systemic inflammatory responses by reducing the levels of cytokines and organ tissue damage during CPB. Rats were assigned to groups that underwent CPB with a high priming volume (PV) of 15 ml and a surface area of 0.044 m2 or a low PV of 7 ml and a surface area of 0.034 m2. We measured serum levels of cytokines and biochemical markers during CPB. Levels of proinflammatory cytokines and biochemical markers were significantly elevated in the group with a high PV, than low PV at 60 min, whereas none of these factors significantly differed between the groups at 120 min. These data suggested that in addition to blood being in contact with surfaces, the duration of CPB exposure is also an important factor for nonlinear time variances in damage caused by the systemic inflammatory response.
Darcy Permeability of Hollow Fiber Membrane Bundles Made from Membrana Polymethylpentene Fibers Used in Respiratory Assist Devices
Authors: Madhani Shalv. P. , D’Aloiso Brandon D. , Frankowski Brian , Federspiel William. J.
Published: January 2016

Hollow fiber membranes (HFMs) are used in blood oxygenators for cardiopulmonary bypass or in next generation artificial lungs. Flow analyses of these devices is typically done using computational fluid dynamics (CFD) modeling HFM bundles as porous media, using a Darcy permeability coefficient estimated from the Blake–Kozeny (BK) equation to account for viscous drag from fibers. We recently published how well this approach can predict Darcy permeability for fiber bundles made from polypropylene HFMs, showing the prediction can be significantly improved using an experimentally derived correlation between the BK constant (A) and bundle porosity (ε). In this study, we assessed how well our correlation for A worked for predicting the Darcy permeability of fiber bundles made from Membrana polymethylpentene (PMP) HFMs, which are increasingly being used clinically. Swatches in the porosity range of 0.4 to 0.8 were assessed in which sheets of fiber were stacked in parallel, perpendicular, and angled configurations. Our previously published correlation predicted Darcy within ±8%. A new correlation based on current and past measured permeability was determined: A = 497ε − 103; using this correlation measured Darcy permeability was within ±6%. This correlation varied from 8% to −3.5% of our prior correlation over the tested porosity range.
Arrhythmias in Patients with Cardiac Implantable Electrical Devices after Implantation of a Left Ventricular Assist Device
Authors: Rosenbaum Andrew N. , Kremers Walter K. , Duval Sue , Sakaguchi Scott , John Ranjit , Eckman Peter M.
Published: January 2016

Utilization of continuous-flow left ventricular assist devices (CF-LVADs) for advanced heart failure is increasing, and the role of cardiac implantable electrical devices (CIED) is unclear. Prior studies of the incidence of arrhythmias and shocks are frequently limited by ascertainment. One hundred and seventy-eight patients were examined with a previous CIED who were implanted with a CF-LVAD. Medical history, medications, and CIED data from device interrogations were gathered. A cardiac surgery control group (n = 38) was obtained to control for surgical factors. Several clinically significant events increased after LVAD implantation: treated-zone ventricular arrhythmias (VA; p < 0.01), monitored-zone VA (p < 0.01), antitachycardia pacing (ATP)-terminated episodes (p < 0.01), and shocks (p = 0.01), although administered shocks later decreased (p < 0.01). Presence of a preimplant VA was associated with postoperative VA (odds ratio [OR]: 4.31; confidence interval [CI]: 1.5–12.3, p < 0.01). Relative to cardiac surgery, LVAD patients experienced more perioperative events (i.e., monitored VAs and shocks, p < 0.01 and p = 0.04). Neither implantable cardioverter defibrillator (ICD) shocks before implant nor early or late postimplant arrhythmias or shocks predicted survival (p = 0.07, p = 0.55, and p = 0.55). Our experience demonstrates time-dependent effects on clinically significant arrhythmias after LVAD implantation, including evidence that early LVAD-related arrhythmias may be caused by the unique arrhythmogenic effects of VAD implant.
Development of a Mock Extracorporeal Membrane Oxygenation Circuit to Assess Recirculation
Authors: Jayewardene Ishanth Devinda , Xie Ashleigh , Iyer Arjun , Pye Roger , Dhital Kumud
Published: January 2016

A limitation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) is the recirculating of newly oxygenated blood back to the VV-ECMO circuit. We compared cannulation strategies for combating recirculation utilizing a mock circulation loop (MCL) with ultrasonic flow probes and pressure transducers ensuring that the MCL was run at physiological hemodynamic parameters. Mean recirculation percentages were lower (ANOVA, F = 14.25; p = 0.0001) with the Wang-Zwische dual lumen cannula (4.00 ± 1.77, n = 7) than both the femoro-jugular (15.23 ± 7.00, n = 8) and the femoro-femoral cannulation configurations (13.49 ± 1.44, n = 8).
Point-of-Care Rapid-Seeding Ventricular Assist Device with Blood-Derived Endothelial Cells to Create a Living Antithrombotic Coating
Authors: Noviani Maria , Jamiolkowski Ryan M. , Grenet Justin E. , Lin Qiuyu , Carlon Tim A. , Qi Le , Jantzen Alexandra E. , Milano Carmelo A. , Truskey George A. , Achneck Hardean E.
Published: January 2016

The most promising alternatives to heart transplantation are left ventricular assist devices and artificial hearts; however, their use has been limited by thrombotic complications. To reduce these, sintered titanium (Ti) surfaces were developed, but thrombosis still occurs in approximately 7.5% of patients. We have invented a rapid-seeding technology to minimize the risk of thrombosis by rapid endothelialization of sintered Ti with human cord blood-derived endothelial cells (hCB-ECs). Human cord blood-derived endothelial cells were seeded within minutes onto sintered Ti and exposed to thrombosis-prone low fluid flow shear stresses. The hCB-ECs adhered and formed a confluent endothelial monolayer on sintered Ti. The exposure of sintered Ti to 4.4 dynes/cm2 for 20 hr immediately after rapid seeding resulted in approximately 70% cell adherence. The cell adherence was not significantly increased by additional ex vivo static culture of rapid-seeded sintered Ti before flow exposure. In addition, adherent hCB-ECs remained functional on sintered Ti, as indicated by flow-induced increase in nitric oxide secretion and reduction in platelet adhesion. After 15 day ex vivo static culture, the adherent hCB-ECs remained metabolically active, expressed endothelial cell functional marker thrombomodulin, and reduced platelet adhesion. In conclusion, our results demonstrate the feasibility of rapid-seeding sintered Ti with blood-derived hCB-ECs to generate a living antithrombotic surface.
First North American 50 cc Total Artificial Heart Experience: Conversion from a 70 cc Total Artificial Heart
Authors: Khalpey Zain , Kazui Toshinobu , Ferng Alice S. , Connell Alana , Tran Phat L. , Meyer Mark , Rawashdeh Badi , Smith Richard G. , Sweitzer Nancy K. , Friedman Mark , Lick Scott , Slepian Marvin J. , Copeland Jack G.
Published: January 2016

The 70 cc total artificial heart (TAH) has been utilized as bridge to transplant (BTT) for biventricular failure. However, the utilization of 70 cc TAH has been limited to large patients for the low output from the pulmonary as well as systemic vein compression after chest closure. Therefore, the 50 cc TAH was developed by SynCardia (Tucson, AZ) to accommodate smaller chest cavity. We report the first TAH exchange from a 70 to 50 cc due to a fit difficulty. The patient failed to be closed with a 70 cc TAH, although the patient met the conventional 70 cc TAH fit criteria. We successfully closed the chest with a 50 cc TAH.
Role of Bismuth in the Eradication of Helicobacter pylori
Authors: Alkim Huseyin , Koksal Ali Riza , Boga Salih , Sen Ilker , Alkim Canan
Published: January 2016

Bismuth salts exert their activity within the upper gastrointestinal tract through action of luminal bismuth. Bismuth exerts direct bactericidal effect on Helicobacter pylori by different ways: forms complexes in the bacterial wall and periplasmic space, inhibits different enzymes, ATP synthesis, and adherence of the bacteria to the gastric mucosa. Bismuth also helps ulcer healing by acting as a barrier to the aggressive factors and increasing mucosal protective factors such as prostaglandin, epidermal growth factor, and bicarbonate secretion. To date, no resistance to bismuth has been reported. Also synergism between bismuth salts and antibiotics was present. It was shown that metronidazole and clarithromycin resistant H. pylori strains become susceptible if they are administered together with bismuth. Bismuth-containing quadruple therapy was recommended both by the Second Asia-Pacific Consensus Guidelines and by the Maastricht IV/Florence Consensus Report as an alternative first choice regimen to standard triple therapy, in areas with low clarithromycin resistance, and it is recommended as the first-line therapeutic option in areas with a high prevalence of clarithromycin resistance. Greater than 90% eradication success can be obtained by bismuth-containing quadruple therapy. Choosing bismuth as an indispensable part of first-line therapy is logical as both metronidazole and clarithromycin resistances can be overcome by adding bismuth to the regimen.
Constipation and Outcomes of Cecostomy
Authors: Arya Shruti , Gupta Nancy , Gupta Rahul , Aggarwal Arun
Published: January 2016

Constipation, defined as delay or difficulty in defecation, present for 2 or more weeks, is a common problem encountered by both primary and specialty medical providers. There are no randomized controlled trials on the use of antegrade enemas in the pediatric population. Most published papers are based on the experience at a particular center. The aim of this article is to describe the pathophysiology of constipation, review the contribution of colonic manometry to the diagnosis of constipation, summarize the advancements in the management of constipation through the use of antegrade enemas, and study the outcomes of cecostomy at different centers. This study is a comprehensive literature review generated by computerized search of literature, supplemented by review of monographs and textbooks in pathology, gastroenterology, and surgery. Literature search was performed using the publications from 1997 to 2012. The search included publications of all types presenting or reviewing data on cecostomy. The antegrade continence enema is a therapeutic option for defecation disorders when maximal conventional therapy is not successful. Symptoms of defecation disorders in children with different underlying etiologies improve significantly after a cecostomy is created. In addition, there is a benefit on the patients' physical activity, healthcare utilization, and general well-being. Based on the review of published literature it seems that antegrade enemas are a successful therapeutic option in children with severe constipation and/or fecal incontinence. With the advent of cecostomy buttons, patient compliance and the overall cosmetic appearance have improved.
Strategy for the Prediction of Steady-State Exposure of Digoxin to Determine Drug–Drug Interaction Potential of Digoxin With Other Drugs in Digitalization Therapy
Authors: Srinivas Nuggehally R.
Published: January 2016

Digoxin, a narrow therapeutic index drug, is widely used in congestive heart failure. However, the digitalization therapy involves dose titration and can exhibit drug–drug interaction. Ctrough versus area under the plasma concentration versus time curve in a dosing interval of 24 hours (AUC0–24h) and Cmax versus AUC0–24h for digoxin were established by linear regression. The predictions of digoxin AUC0–24h values were performed using published Ctrough or Cmax with appropriate regression lines. The fold difference, defined as the quotient of the observed/predicted AUC0–24h values, was evaluated. The mean square error and root mean square error, correlation coefficient (r), and goodness of the fold prediction were used to evaluate the models. Both Ctrough versus AUC0–24h (r = 0.9215) and Cmax versus AUC0–24h models for digoxin (r = 0.7781) showed strong correlations. Approximately 93.8% of the predicted digoxin AUC0–24h values were within 0.76-fold to 1.25-fold difference for Ctrough model. In sharp contrast, the Cmax model showed larger variability with only 51.6% of AUC0–24h predictions within 0.76–1.25-fold difference. The r value for observed versus predicted AUC0–24h for Ctrough (r = 0.9551; n = 177; P < 0.001) was superior to the Cmax (r = 0.6134; n = 275; P < 0.001) model. The mean square error and root mean square error (%) for the Ctrough model were 11.95% and 16.2% as compared to 67.17% and 42.3% obtained for the Cmax model. Simple linear regression models for Ctrough/Cmax versus AUC0–24h were derived for digoxin. On the basis of statistical evaluation, Ctrough was superior to Cmax model for the prediction of digoxin AUC0–24h and can be potentially used in a prospective setting for predicting drug–drug interaction or lack of it.