Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers.

Background/aims: There is emerging evidence of gabapentin and pregabalin (gabapentinoid) abuse, particularly in the substance misuse population, and some suggestion of gabapentinoids being abused alongside methadone.

Methods: A questionnaire-based survey was carried out in six substance misuse clinics, looking for evidence of gabapentinoid abuse.

Results: 22% (29/129) of respondents admitted to abusing gabapentinoids, and of these, 38% (11/29) abused gabapentinoids in order to potentiate the 'high' they obtained from methadone.

Hypercoagulability panel testing predicts thrombosis in neonates undergoing cardiac surgery.

Thrombosis contributes to morbidity and mortality in neonates following cardiac surgery. Alterations in hemostatic factors following cardiac surgery have been described, but there is no data correlating these changes with risk of thrombosis in neonates. The aim of this study is to predict thrombosis in neonates undergoing cardiac surgery by assessment of a panel of hypercoagulability markers.

L-Threonine induces heat shock protein expression and decreases apoptosis in heat-stressed intestinal epithelial cells.

Objectives: Osmotically acting amino acids can be cytoprotective following injury. As threonine (THR) induces osmotic cell swelling, our aim was to investigate the potential for THR to induce cellular protection in intestinal epithelial cells and evaluate possible mechanisms of protection.

Methods: Cells treated with a range of THR doses were evaluated following heat stress (HS) injury.

Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years.

Objectives: Previous work in our institution has indicated that the Technical Performance Score (TPS) is highly associated with early outcomes in select subsets of procedures and age groups. We hypothesized that the TPS could predict early outcomes in a wide range of diagnoses and age groups.

Methods: Consecutive patients discharged from January 2011 to March 2013 were prospectively evaluated.

Early propranolol treatment induces lung heme-oxygenase-1, attenuates metabolic dysfunction, and improves survival following experimental sepsis.

Introduction: Pharmacological agents that block beta-adrenergic receptors have been associated with improved outcome in burn injury. It has been hypothesized that injuries leading to a hypermetabolic state, such as septic shock, may also benefit from beta-blockade; however, outcome data in experimental models have been contradictory. Thus, we investigated the effect of beta-blockade with propranolol on survival, hemodynamics, lung heat shock protein (HSP) expression, metabolism and inflammatory markers in a rat cecal ligation and puncture (CLP) model of sepsis.

Predictors of reintervention after repair of interrupted aortic arch with ventricular septal defect.

Background: Left ventricular outflow tract obstruction after neonatal repair of interrupted aortic arch with ventricular septal defect may warrant reintervention. We sought to identify clinical and preoperative echocardiographic predictors of reintervention for postoperative left ventricular outflow tract obstruction.

Methods: Retrospective data were collected on neonates with interrupted aortic arch with ventricular septal defect who underwent single-stage repair from 1995 to 2009.

Hypercoagulability markers predict thrombosis in single ventricle neonates undergoing cardiac surgery.

Background: Incidence of thrombosis in neonates undergoing cardiac surgery is as high as 20%, and single ventricle physiology (SVP) may present an even higher risk. We hypothesize that SVP is a risk factor for thrombosis in neonates undergoing cardiac surgery, and hypercoagulability biomarkers are predictive of postoperative thrombosis.

Methods: Records of 512 neonates undergoing cardiac surgery were retrospectively reviewed.

Inadequate technical performance scores are associated with late mortality and late reintervention.

Background: We have shown previously that technical performance score (TPS) is strongly associated with early mortality and major postoperative adverse events in a diverse group of patients. We now report evaluation of the validity of TPS in predicting late outcomes in the same group of patients.

Methods: Patients who underwent surgery between June 1, 2005 and June 30, 2006 were included.

An evidence-based review of the impact of periprocedural myocardial infarction in carotid revascularization.

Landmark trials comparing carotid endarterectomy (CEA) with medical therapy in patients with symptomatic or asymptomatic atherosclerotic stenosis of extracranial carotid arteries have favored carotid revascularization. Carotid artery stenting (CAS) has emerged as a minimally invasive option for revascularization of carotid artery stenoses and has been shown to be noninferior to CEA, regardless of patient symptom status. Debate continues regarding the importance of periprocedural myocardial infarction (PMI) as an endpoint in carotid revascularization trials.

Surgical repair of truncal valve regurgitation.

Objectives: Truncal valve regurgitation remains a short- and long-term risk factor for patients with truncus arteriosus. There are limited data available on techniques and outcomes of truncal valve repair (TVR). The aim of this study was to report our experience with TVR in patients of all ages.

Biventricular conversion after single-ventricle palliation in unbalanced atrioventricular canal defects.

Background: Management of unbalanced common atrioventricular canal (UCAVC) defect by a single-ventricle (SV) approach frequently results in poor outcomes, especially in trisomy 21 patients. In this report we describe our results with conversion to biventricular circulation in UCAVC patients with SV palliation.

Methods: Retrospective review of patients with UCAVC undergoing biventricular conversion from prior SV palliation between 2003 and 2011 was conducted.

Alfieri repair for post-repair mitral systolic anterior motion in a young child.

An 11-year-old patient with Marfan syndrome presented with severe mitral and tricuspid regurgitation and underwent mitral valve repair consisting of a vertical folding plasty of a redundant and prolapsing A1, closure of a deep cleft-like A1-A2 indentation, and annuloplasty to 28 mm, and tricuspid valve repair. Post-bypass echocardiography showed significant systolic anterior motion of the mitral valve. The annuloplasty was upsized to 34 mm and the A1 folding plasty taken down.

Annulus upsizing for mitral valve re-replacement in children.

Background: Mitral valve replacement remains the last resort for treatment of congenital mitral valve disease. Enlarging the mitral annulus at the time of mitral valve replacement may allow implantation of a larger prosthesis in children.

Methods: All mitral valve replacement procedures from 1990 to 2012 were included, and mitral annulus enlargement techniques were analyzed.

Evaluation of the FilmArray® system for detection of Bacillus anthracis, Francisella tularensis and Yersinia pestis.

Aims: To evaluate the sensitivity and specificity of the BioFire Diagnostics FilmArray(®) system in combination with their Biothreat Panel for the detection of Bacillus anthracis (Ba), Francisella tularensis (Ft) and Yersinia pestis (Yp) DNA, and demonstrate the detection of Ba spores.

Methods And Results: DNA samples from Ba, Ft and Yp strains and near-neighbours, and live Ba spores were analysed using the FilmArray(®) Biothreat Panel, a multiplexed PCR-based assay for 17 pathogens and toxins. Sensitivity studies with DNA indicate that the limit of detection is 250 genome equivalents (GEs) per sample or lower.

Epidermal growth factor receptor expression and signaling are essential in glutamine's cytoprotective mechanism in heat-stressed intestinal epithelial-6 cells.

Epidermal growth factor receptor (EGFR) expression and signaling can induce cellular protection after intestinal inflammation. L-Glutamine (GLN) is known to prevent apoptosis after intestinal injury by activating MAPK and phosphatidylinositol 3-kinase (PI3-K)/Akt pathways. However, the role of EGFR expression and signaling in GLN-mediated cellular protection in intestinal epithelial-6 (IEC-6) cells after heat stress (HS) is unknown.

Fibronectin-integrin signaling is required for L-glutamine's protection against gut injury.

Background: Extracellular matrix (ECM) stabilization and fibronectin (FN)-Integrin signaling can mediate cellular protection. L-glutamine (GLN) is known to prevent apoptosis after injury. However, it is currently unknown if ECM stabilization and FN-Integrin osmosensing pathways are related to GLN's cell protective mechanism in the intestine.

Estimated copy number of Bacillus anthracis plasmids pXO1 and pXO2 using digital PCR.

We evaluated digital PCR (dPCR) to directly enumerate plasmid and chromosome copies in three strains of Bacillus anthracis. Copy number estimates based on conventional quantitative PCR (qPCR) highlighted the variability of using qPCR to measure copy number whereas estimates based on direct sequencing are comparable to dPCR.

Surgical technical performance scores are predictors of late mortality and unplanned reinterventions in infants after cardiac surgery.

Objective: We have previously shown that surgical Technical Performance Scores (TPS) are important predictors of early postoperative morbidity across a wide spectrum of procedures and that intraoperative recognition and intervention of residual defects resulted in improved outcomes. We hypothesized that these scores would also be important predictors of midterm outcomes.

Methods: Neonates and infants aged younger 6 months were prospectively followed from the index surgery for a minimum of 1 year.

Technical performance scores in congenital cardiac operations: a quality assessment initiative.

Background: Technical performance in congenital cardiac operations and its association with clinical outcomes was previously examined in infants and neonates. The purpose of this study was the development and implementation of a system for measuring technical performance in the majority of congenital cardiac operations to be used as a surgeon's self-assessment tool.

Methods: Using the methodologic framework piloted at our institution, measures of technical performance were created for more than 90% of all congenital cardiac operations.

Recurrent atrioventricular groove intramuscular arteriovenous malformation.

A 17-year-old patient presented with a recurrent right atrioventricular (AV) groove vascular tumor. The tumor was resected en bloc, including the AV groove extending into the right ventricle (RV) and tricuspid valve. The AV groove and tricuspid valve required extensive reconstruction.