Integrating a Virtual ICU with Cardiac and Cardiovascular ICUs: Managing the Needs of a Complex and High-Acuity Specialty ICU Cohort.

A long-standing shortage of critical care intensivists and nurses, exacerbated by the coronavirus disease (COVID-19) pandemic, has led to an accelerated adoption of tele-critical care in the United States (US). Due to their complex and high-acuity nature, cardiac, cardiovascular, and cardiothoracic intensive care units (ICUs) have generally been limited in their ability to leverage tele-critical care resources. In early 2020, Houston Methodist Hospital (HMH) launched its tele-critical care program called Virtual ICU, or vICU, to improve its ICU staffing efficiency while providing high-quality, continuous access to in-person and virtual intensivists and critical care nurses.

Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systematic Review and Meta-Analysis.

In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a potentially devastating complication associated with significant morbidity, and mortality. To reduce the risk of stroke, cerebral protection devices (CPD) were developed to prevent debris from embolizing to the brain during TAVI. We performed a systematic review and meta-analysis to determine the safety and efficacy of CPD in TAVI.

Defining Vasoplegia Following Durable, Continuous Flow Left Ventricular Assist Device Implantation.

This study aimed to develop a definition of vasoplegia that reliably predicts clinical outcomes. Vasoplegia was evaluated using data from the electronic health record for each 15-minute interval for 72 hours following cardiopulmonary bypass. Standardized definitions considered clinical features (systemic vascular resistance [SVR], mean arterial pressure [MAP], cardiac index [CI], norepinephrine equivalents [NEE]), threshold strategy (criteria occurring in any versus all measurements in an interval), and duration (criteria occurring over multiple consecutive versus separated intervals).

Metastatic Spread of Neuroblastoma to the Left Atrium Mimicking Atrial Myxoma: A Rare Occurrence in an Adolescent.

Neuroblastoma is the most common childhood malignancy arising from the sympathetic neuroblast cells. The most common sites of origin are the adrenal glands and paravertebral regions. However, the involvement of the heart is a rare occurrence in adolescents.

An Unusual Case of Alveolar Rhabdomyosarcoma of the Neck in an Adult Patient.

Rhabdomyosarcoma is the most common soft tissue malignancy in adolescents. It is extremely rare for sarcomas to occur in patients more than 18 years of age. We present a case of rhabdomyosarcoma originating in skeletal muscles on the right side of the neck.

At-line high throughput site-specific glycan profiling using targeted mass spectrometry.

Protein post-translational modification (PTM) plays an important role in many biological processes; of which glycosylation is arguably one of the most complex and diverse modifications and is crucial for the safety and efficacy of biotherapeutic proteins. Mass spectrometric characterization of protein glycosylation is well established with clear advantages and disadvantages; on one hand it is precise and information-rich, as well as being relative inexpensive in terms of the reagents and consumables despite the instrumentation cost and, depending on the method, can give site specific information; on the other hand it generally suffers from low throughput, restriction to largely purified samples and is less quantitative, especially for sialylated glycan species. Here, we describe a high throughput, site-specific, targeted mass spectrometric peptide mapping approach to quickly screen/rank candidate production cell lines and culture conditions that give favourable glycosylation profiles directly from conditioned culture media for an Fc-fusion protein.

An Adult Kawasaki Disease with Coronary Artery Involvement: A Unique Case Report and Literature Review.

Kawasaki disease (KD) is an acute, febrile, vasculitis of mainly large to medium-sized vessels. KD is a self-limited illness of infancy and childhood and 80% of the patients are younger than four years of age with an incidence of 5.6/100,000 in the United States.

A Rare Case Report of Biloma After Cholecystectomy.

Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity. It is a rare condition with an incidence of 0.3%-2%.

Interfacial Adsorption of a Monoclonal Antibody and Its Fab and Fc Fragments at the Oil/Water Interface.

The physical stability of a monoclonal antibody (mAb) solution for injection in a prefilled syringe may in part depend on its behavior at the silicone oil/water interface. Here, the adsorption of a mAb (termed COE-3) and its fragment antigen-binding (Fab) and crystallizable (Fc) at the oil/water interface was measured using neutron reflection. A 1.

Cardiac Tamponade in the Setting of a Thymoma.

Thymoma is the most common neoplasm originating in the anterior mediastinum and accounts for a quarter of all mediastinal tumors. A pericardial effusion is an uncommon initial manifestation present in approximately 20% of patients. However, our patient had hemorrhagic pericardial effusions causing a cardiac tamponade with bilateral pleural effusions, nodular left pleural based masses, and ascites.

Idiopathic Lateral Rectus Myositis Without Signs of Orbital Inflammation.

Idiopathic orbital inflammation (IOI), also known as orbital pseudotumor, is a nonspecific term that represents inflammation of unknown etiology that could affect various orbital structures. We report a case of IOI with an atypical presentation mimicking other clinical conditions. Our patient did not show the typical signs of inflammation that are usually seen in patients with orbital pseudotumor and are paramount in its diagnosis.

A Challenging Diagnosis of Systemic Lupus Erythematosus with Status Epilepticus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder of unknown pathogenesis. In SLE, the body's immune system mistakenly attacks healthy tissues and organs thereby involving multiple body systems including joints, skin, blood, brain, heart, and lungs. SLE has a wide variation in the symptoms, hence making the diagnosis more challenging at the time of initial presentation.

Improving breast cancer screening rates in a primary care setting.

Biannual mammogram has been recommended for all women aged 50-74 years by USPSTF. Our aim was to improve the screening rates of biannual mammogram among women aged 50-74 years in a primary care clinic. Medical records were reviewed.

Plasma cell leukemia - one in a million: A case report.

Background: Plasma cell leukemia (PCL) is diagnosed by the presence of an absolute plasma cell count of > 2 × 10/L or 20% plasma cells in the peripheral blood. Because the incidence of PCL is relatively low, our case report study presents a rare opportunity to describe the clinical and pathological characteristics of this leukemia, as well as different modalities of treatment and outcomes of primary PCL (pPCL).

Case Summary: A 56-year-old male with a history of hypertension complained of pain in the left flank area which started four months prior to admission.

A Rare Case of Crohn's Disease Manifesting as a Large Liver Abscess.

Liver abscess is a rare complication seen in Crohn's disease (CD) and has been rarely reported. Our aim is to illustrate a case of liver abscess in a patient with CD and the importance of a complete history and physical examination in identifying the potential cause of a hepatic abscess in an immune competent individual in who the diagnosis of CD was apparently ignored for two years before she presented to us. Although the manifestation of a hepatic abscess without any perianal abscess or fistula in CD is extremely rare, recognition of this would facilitate the diagnosis and appropriate management of abscess and CD.

The Role and Impact of Extracorporeal Membrane Oxygenation in Critical Care.

Use of extracorporeal membrane oxygenation (ECMO) has been exponentially increasing over the last decade and is now considered a mainstream lifesaving treatment modality in critical care medicine. However, the need for physician education, training, and experience remains imperative. Although ECMO has traditionally been used in end-stage lung disease and circulatory collapse, it is being adopted for use in right heart failure, as a bridge to heart and lung transplantation, and as rescue therapy for both sepsis and post-organ transplantation.

How New Support Devices Change Critical Care Delivery.

Mechanical support devices are used to support failing cardiac, respiratory, or both systems. Since Gibbon developed the cardiopulmonary bypass in 1953, collaborative efforts by medical centers, bioengineers, industry, and the National Institutes of Health have led to development of mechanical devices to support heart, lung, or both. These devices are used as a temporary or long-term measures for acute collapse of circulatory system and/or respiratory failure.

Developing and testing a comprehensive tool to assess family meetings: Empirical distinctions between high- and low-quality meetings.

Background: The heterogeneity with regard to findings on family meetings (or conferences) suggests a need to better understand factors that influence family meetings. While earlier studies have explored frequency or timing of family meetings, little is known about how factors (such as what is said during meetings, how it is said, and by whom) influence family meeting quality.

Objectives: (1) To develop an evaluation tool to assess family meetings (Phase 1); (2) to identify factors that influence meeting quality by evaluating 34 family meetings (Phase 2).

Beta-catenin is a mediator of the response of fibroblasts to irradiation.

Radiation causes soft tissue complications that include fibrosis and deficient wound healing. beta-Catenin, a key component in the canonical Wnt-signaling pathway, is activated in fibrotic processes and wound repair and, as such, could play a role in mediating cellular responses to irradiation. beta-Catenin can form a transcriptionally active complex with members of the Tcf family.