Evaluating vancomycin and piperacillin-tazobactam in ED patients with severe sepsis and septic shock.

Study Objective: To determine the frequency and cause of inadequate initial antibiotic therapy with vancomycin and piperacillin-tazobactam in patients with severe sepsis and septic shock in the emergency department (ED), characterize its impact on patient outcomes, and identify patients who would benefit from an alternative initial empiric regimen.

Methods: Retrospective cohort study conducted between 2012 and 2015 in which 342 patients with culture-positive severe sepsis or septic shock who received initial vancomycin and piperacillin-tazobactam were reviewed to determine appropriateness of antimicrobial therapy, risk factors for inappropriate use, and outcome data. Univariate and multivariate regression analyses were determined to identify associations between inappropriate antibiotic use and outcomes and to identify risk factors that may predict which patients would benefit from an alternative initial regimen.

Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels.

Tibial plateau fractures may result in significant limitations postoperatively. Studies have described outcomes of arthroscopic-assisted percutaneous fixation (AAPF) of these injuries but have rarely reported postoperative activity levels. Between 2009 and 2013, patients who sustained a lateral split, split depression, or pure depression type tibial plateau fracture (Schatzker types I-III fractures) and underwent outpatient AAPF were eligible for the study.

Isolated fibular collateral ligament injuries in athletes.

Isolated injuries to the fibular collateral ligament (FCL) are rare. Although recent data suggest that operative and nonoperative treatment can both result in good functional outcomes, limited data exist on return to play for nonoperative treatment of FCL injuries and the value of magnetic resonance imaging in predicting prognosis. In this article, we present a review of the current literature and present a focused review regarding the diagnosis, treatment, and prognosis of FCL injuries, as well as the senior authors experience and a cohort of National Football League players.

Cell-based screening using high-throughput flow cytometry.

This review describes the use of high-throughput flow cytometry for performing multiplexed cell-based and bead-based screens. With the many advances in cell-based analysis and screening, flow cytometry has historically been underutilized as a screening tool largely due to the limitations in handling large numbers of samples. However, there has been a resurgence in the use of flow cytometry due to a combination of innovations around instrumentation and a growing need for cell-based and bead-based applications.

Scoliosis caused by rib fusion following thoracotomy for tracheoesophageal fistula: case report.

Scoliosis as a late complication of thoracotomy has been described previously, but reports are rare. We present the case of a 22-year-old female referred for symptomatic scoliosis. Radiographs demonstrated a severe, structural, upper-thoracic scoliosis with associated right-sided rib fusions.

Prevalence of the metabolic syndrome in an incident dialysis population.

The National Heart, Lung, and Blood Institute's National Cholesterol Education Program 2001 Adult Treatment Panel III report defined the metabolic syndrome as having at least 3 of the following 5 criteria: abdominal obesity, elevated triglyceride levels, low high-density lipoprotein cholesterol levels, an elevated blood pressure, and an elevated fasting glucose. Evidence is accumulating to suggest that the metabolic syndrome predisposes to cardiovascular disease (CVD). End-stage kidney disease (ESKD) patients requiring dialysis have a substantially elevated risk of CVD morbidity and mortality.

Overview of informatics for high content screening.

With the growing use of high content screening (HCS) and analysis in drug discovery and systems biology, informatics has come to the forefront as a critical technology to effectively utilize the massive volumes of high content data and images being generated. Informatics technologies are required to transform HCS data and images into useful information and then into knowledge to drive decision making in an efficient and cost effective manner. In this chapter, we provide an overview of informatics tools and technologies for HCS, discuss some of the challenges of harnessing the huge and growing volumes of HCS data, and provide insight to help toward implementing or selecting, and utilizing a high content informatics solution to meet your organization's needs.

Requirement for Rac1-dependent NADPH oxidase in the cardiovascular and dipsogenic actions of angiotensin II in the brain.

We have shown that intracellular superoxide (O(2)(*-)) production in CNS neurons plays a key role in the pressor, bradycardic, and dipsogenic actions of Ang II in the brain. In this study, we tested the hypothesis that a Rac1-dependent NADPH oxidase is a key source of O(2)(*-) in Ang II-sensitive neurons and is involved in these central Ang II-dependent effects. We performed both in vitro and in vivo studies using adenoviral (Ad)-mediated expression of dominant-negative Rac1 (AdN17Rac1) to inhibit Ang II-stimulated Rac1 activation, an obligatory step in NADPH oxidase activation.

Reteplase for dysfunctional hemodialysis catheter clearance.

Study Objective: To evaluate the efficacy of reteplase administration in clearing hemodialysis catheters.

Design: Open-label, uncontrolled, observational trial.

Setting: University medical center.

Delayed superficialization of brachiobasilic fistula: technique and initial experience.

Hypothesis: Angioaccess procedures for dialysis have varied patency rates with frequent need for intervention. A superficialized arteriovenous brachiobasilic fistula created as a 2-step procedure will have good long-term patency with minimal complication.

Design: Retrospective medical record review and patient interview.

Extrapulmonary tuberculosis in patients with end stage renal disease--two case reports and a brief review.

Chronic renal failure is a risk factor for tuberculosis. In the past five years we have identified two cases of tuberculosis in our dialysis population. The first patient, showed chronic failure to thrive on hemodialysis.

Hyperkalemia in hospitalized patients.

Objective: Evaluate the prevalence of hyperkalemia (potassium > 5.5 mmol/l) in hospitalized patients not on dialysis, as well as the association of medications, impaired renal function and comorbid conditions with hyperkalemia.

Design: A retrospective case-control method.

Rhabdomyolysis and acute renal failure after changing statin-fibrate combinations.

Statin-fibrate combinations are commonly used to treat hyperlipidemia. These drugs have been previously reported to cause rhabdomyolysis with acute renal failure. Whether different statin-fibrate combinations have different risks for rhabdomyolysis is not known.

A comparison of parathyroid-gland function in haemodialysis patients with different forms of renal osteodystrophy.

Parathyroid function was studied in three different histological forms of renal osteodystrophy: osteitis fibrosa (OF), low-turnover aluminium-associated bone disease (LTAABD), and aplastic bone disease without aluminium (ABD). Parathyroid function was determined by the evaluation of the sigmoidal parathyroid hormone-(PTH)-calcium curve, which was obtained by the performance of a reduced calcium and an increased calcium haemodialysis. Parameters of the sigmoidal PTH-calcium curve evaluated included maximally stimulated (PTHMax) and inhibited (PTHMin) PTH, the set point of calcium for PTH (ICA50), defined as the ionised calcium concentration at which PTHMax was reduced by 50%, the ratio of basal PTH to maximally stimulated PTH (PTHBase:PTHMax), the ionised calcium concentration at which basal (ICABase), maximally stimulated (ICAMax), and maximally inhibited (ICAMin) PTH values were observed, and the slope of the PTH-calcium curve.

Two-needle calculation of recirculation compared with the standard three-needle method.

A two-needle method for calculating recirculation was compared with the standard three-needle method, substituting the standard phlebotomy of a remote vessel during dialysis with blood obtained from the dialyzer inlet needle 15 minutes after the termination of dialysis. Twenty patients were studied prospectively. There was no significant difference between corrected blood flow calculated with the standard and two-needle methods.

PTH receptor coupling to phospholipase C is an alternate pathway of signal transduction in bone and kidney.

The parathyroid hormone (PTH) receptor is coupled via a guanine nucleotide-binding regulatory protein (G protein) to phospholipase C (PLC). Binding of PTH to its receptor leads to activation of PLC with the subsequent hydrolysis of phosphatidylinositol 4,5-bisphosphate to inositol 1,4,5-trisphosphate (IP3) and diacylglycerol (DAG). IP3 generation leads to the release of intracellular calcium stores, which produces an increase in the intracellular calcium concentration.

Direct inhibitory effect of calcitriol on parathyroid function (sigmoidal curve) in dialysis.

The effect of intravenous calcitriol on parathyroid function was evaluated in nine chronic hemodialysis patients with secondary hyperparathyroidism. Two micrograms of calcitriol were administered intravenously after dialysis thrice weekly for ten weeks. Parathyroid function was assessed by inducing hypo- and hypercalcemia with low calcium (1.

Nebulized albuterol for acute hyperkalemia in patients on hemodialysis.

Study Objective: To determine the efficacy and safety of nebulized albuterol in the acute treatment of hyperkalemia in patients on chronic hemodialysis.

Design: Prospective, double-blind, and placebo-controlled study.

Setting: Outpatient hemodialysis clinic at a university medical center.