Interactive contribution of hyperinsulinemia, hyperglycemia, and mammalian target of rapamycin signaling to valvular interstitial cell differentiation and matrix remodeling.

Diabetes and its major key determinants insulin resistance and hyperglycemia are known risk factors for calcific aortic valve disease (CAVD). The processes leading to molecular and structural alterations of the aortic valve are yet not fully understood. In previous studies, we could show that valvular interstitial cells (VIC) display canonical elements of classical insulin signaling and develop insulin resistance upon hyperinsulinemia and hyperglycemia accompanied by impaired glucose metabolism.

Airway management of congenital pulmonary airway malformation resection in neonates and infants: A case cohort study.

Background: Anesthestic management of congenital pulmonary airway malformation has not been well described in the literature. It is not clear whether one-lung ventialtion is indicated during thoracoscopic lobectomy and if so, what is the best technique achieve it.

Aims: We describe the variables with the two commonly performed surgical techniques, thoracoscopic lobectomy and open thoracotomy, from our institutional database to assess the role of lung isolation and the preferable method of lung isolation technique for congenital pulmonary airway malformation resections.

Improving on-time start of day and end of day for a pediatric surgical service.

Background And Objective: In multicase pediatric ear, nose, and throat operating rooms (ORs), brief delays in early case start times often produce a cascading effect of lengthy delays by the end of the day and can often lead to patient, family, and staff dissatisfaction and increased labor costs due to unplanned overtime. We sought to improve actual end of day relative to scheduled end of day from 40% to 60%.

Methods: Key drivers of the process included case scheduling, ordering of sedative medications, and nurse availability in the post anesthesia care unit to receive the patient from the anesthesia provider.

Getting started with the model for improvement: psychology and leadership in quality improvement.

Although the case for quality in hospitals is compelling, doctors are often uncertain how to achieve it. This article forms the third and final part of a series providing practical guidance on getting started with a first quality improvement project. Introduction.