Evaluation of bivalirudin treatment for heparin-induced thrombocytopenia in critically ill patients with hepatic and/or renal dysfunction.

Study Objective: To evaluate the safety, effectiveness, and dosing of bivalirudin for treatment of heparin-induced thrombocytopenia (HIT) in critically ill patients with hepatic and/or renal dysfunction.

Design: Retrospective cohort study.

Setting: University-affiliated medical center

Patients: Eighteen patients older than 18 years who were admitted to the intensive care unit (ICU), had hepatic and/or renal dysfunction, and were treated with bivalirudin for the diagnosis of HIT between January 1, 2004, and March 31, 2005.

MyD88 deficiency enhances acquisition and transmission of Borrelia burgdorferi by Ixodes scapularis ticks.

Borrelia burgdorferi strains exhibit various degrees of infectivity and pathogenicity in mammals, which may be due to their relative ability to evade initial host immunity. Innate immune cells recognize B. burgdorferi by Toll-like receptors (TLRs) that use the intracellular molecule MyD88 to mediate effector functions.

Effect of a closed drug-delivery system on the incidence of nosocomial and catheter-related bloodstream infections in infants.

We conducted a prospective, cohort study at two affiliated level III neonatal intensive care units to evaluate the effect of a closed drug-delivery system on the incidence of nosocomial and catheter-related bloodstream infections (CRBSI) in infants. A total of 300 infants (n=150 at each site) were enrolled over a 4-year study period. There was no difference in the rate of CRBSI per 1000 catheter days between the two sites (16.

Evidence that donor intrinsic response to G-CSF is the best predictor of acute graft-vs-host disease following allogeneic peripheral blood stem cell transplantation.

Objective: Risk factors of acute graft-vs-host disease (GVHD) following allogeneic bone marrow transplantation have been well described before. In this study, we tested the hypothesis that acute GVHD after allogeneic peripheral blood stem cell (PBSC) transplant might be associated with donors' responsiveness to granulocyte colony-stimulating factor (G-CSF), rather than the dose of CD34(+) cells infused.

Patients And Methods: We retrospectively analyzed mobilization and transplant data (demographic characteristics, donor blood cell subsets after G-CSF, graft composition) in 149 consecutive HLA-identical donor/recipient pairs in order to identify acute GVHD risk factors.

Evaluation of diagnostic tests and argatroban or lepirudin therapy in patients with suspected heparin-induced thrombocytopenia.

Study Objectives: To evaluate diagnostic tests for heparin-induced thrombocytopenia (HIT), a serious drug reaction that can occur in patients receiving heparin, and to evaluate treatment with direct thrombin inhibitors-the only initial drug therapy that decreases the risk of thromboembolism associated with immune-mediated HIT.

Design: Retrospective cohort study.

Setting: University teaching hospital.

Forest fragmentation predicts local scale heterogeneity of Lyme disease risk.

Fragmentation of the landscape has been proposed to play an important role in defining local scale heterogeneity in Lyme disease risk through influence on mammalian host density and species composition. We tested this observed relationship in a suburban region around Lyme, Connecticut, where we collected data on the density of the tick vector, Ixodes scapularis and prevalence of the Lyme bacterium, Borrelia burgdorferi at 30 sites. Analysis of the landscape pattern of forest patches was performed using satellite imagery.

Nosocomial infections due to multidrug-resistant Pseudomonas aeruginosa: epidemiology and treatment options.

Pseudomonas aeruginosa is one of the leading gram-negative organisms associated with nosocomial infections. The increasing frequency of multi-drug-resistant Pseudomonas aeruginosa (MDRPA) strains is concerning as efficacious antimicrobial options are severely limited. By searching MEDLINE from January 1966-February 2005 and relevant journals for abstracts, we reviewed the frequency, risk factors, and patient outcomes of MDRPA nosocomial infections in critically ill patients, determined the available antimicrobial therapies, and then provided recommendations for clinicians.

The Lyme disease agent exploits a tick protein to infect the mammalian host.

The Lyme disease agent, Borrelia burgdorferi, is maintained in a tick-mouse cycle. Here we show that B. burgdorferi usurps a tick salivary protein, Salp15 (ref.

Diversity of ganglion cells in the mouse retina: unsupervised morphological classification and its limits.

The dendritic structures of retinal ganglion cells in the mouse retina were visualized by particle-mediated transfer of DiI, microinjection of Lucifer yellow, or visualization of green fluorescent protein expressed in a transgenic strain. The cells were imaged in three dimensions and the morphologies of a series of 219 cells were analyzed quantitatively. A total of 26 parameters were studied and automated cluster analysis was carried out using the k-means methods.

Vasopressin, not octreotide, may be beneficial in the treatment of hepatorenal syndrome: a retrospective study.

Background: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis and is associated with high mortality. Ornipressin and terlipressin are effective in treatment of HRS, but are not available in the USA. The efficacy of vasopressin (AVP) and octreotide (OCT) infusions, commonly utilized in the USA, in the treatment of HRS is unknown.

Pharmacokinetics and pharmacodynamics of imipenem during continuous renal replacement therapy in critically ill patients.

The pharmacokinetics of imipenem were studied in adult intensive care unit (ICU) patients during continuous venovenous hemofiltration (CVVH; n=6 patients) or hemodiafiltration (CVVHDF; n=6 patients). Patients (mean+/-standard deviation age, 50.9+/-15.

fMRI temporal clustering analysis in patients with frequent interictal epileptiform discharges: comparison with EEG-driven analysis.

Temporal clustering analysis (TCA) is an exploratory data-driven technique that has been proposed for the analysis of resting fMRI to localise epileptiform activity without need for simultaneous EEG. Conventionally, fMRI of epileptic activity has been limited to those patients with subtle clinical events or frequent interictal epileptiform EEG discharges, requiring simultaneous EEG recording, from which a linear model is derived to make valid statistical inferences from the fMRI data. We sought to evaluate TCA by comparing the results with those of EEG correlated fMRI in eight selected cases.

Outcomes of paclitaxel-eluting stent implantation in patients with stenosis of the left anterior descending coronary artery.

Objectives: We sought to examine the efficacy of paclitaxel-eluting stent implantation in the left anterior descending coronary artery (LAD).

Background: Restenosis and recurrent cardiac events after percutaneous intervention are more common for lesions in the LAD than other native coronary arteries, and often necessitate bypass surgery. Drug-eluting stents may improve the long-term prognosis of this high-risk group.

Hip migration percentage in children with cerebral palsy treated with botulinum toxin type A.

Objective: To determine hip radiographic findings in children with cerebral palsy (CP) treated with botulinum toxin type A (BTX-A).

Design: Retrospective chart review with correlation to radiographic findings.

Setting: Academic center.

Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool.

Autopsy series have revealed patterns of injury in graft-versus-host disease and provided insight into infectious and toxic complications following hematopoietic stem cell transplantation (HSCT). Overall autopsy rates have declined significantly in recent decades including specialized services such as neonatal medicine and cardiac care. However, rates of post-mortem exams at HSCT centers have not been specifically documented.

An ecological approach to preventing human infection: vaccinating wild mouse reservoirs intervenes in the Lyme disease cycle.

Many pathogens, such as the agents of West Nile encephalitis and plague, are maintained in nature by animal reservoirs and transmitted to humans by arthropod vectors. Efforts to reduce disease incidence usually rely on vector control or immunization of humans. Lyme disease, for which no human vaccine is currently available, is a commonly reported vector-borne disease in North America and Europe.

National surveillance of antimicrobial resistance in Pseudomonas aeruginosa isolates obtained from intensive care unit patients from 1993 to 2002.

Nosocomial infections caused by Pseudomonas aeruginosa in critically ill patients are often difficult to treat due to resistance to multiple antimicrobials. The purpose of this study was to evaluate antimicrobial resistance among P. aeruginosa isolates from intensive care unit patients in the United States from 1993 to 2002 by using the Intensive Care Unit Surveillance Study database.

A dispersal model for the range expansion of blacklegged tick (Acari: Ixodidae).

The blacklegged tick, Ixodes scapularis Say, a vector for the agents of Lyme borreliosis and other diseases, has expanded its range dramatically over the past 20 yr. However, the relative contributions of different vertebrate host species to this expansion have remained largely unexplored. To address this issue, we simulated the expansion of a theoretical tick population across a simple landscape by using a deterministic, spatially explicit, cellular automata model.

Estimating population size and drag sampling efficiency for the blacklegged tick (Acari: Ixodidae).

Estimates of absolute density were determined over a 5-yr period (1990-1994) for a population of Ixodes scapularis Say located in Westchester County, NY, by mark-release-recapture (nymphs and adults) and removal (larvae) methods. Density estimates for larvae ranged from 5.2 to 16.

Interaction and transmission of two Borrelia burgdorferi sensu stricto strains in a tick-rodent maintenance system.

In the northeastern United States, the Lyme disease agent, Borrelia burgdorferi sensu stricto, is maintained by enzoonotic transmission, cycling between white-footed mice (Peromyscus leucopus) and black-legged ticks (Ixodes scapularis). B. burgdorferi sensu stricto is genetically variable and has been divided into three major genotypes based on 16S-23S ribosomal DNA spacer (RST) analysis.

EEG/functional MRI in epilepsy: The Queen Square Experience.

The recording of EEG during functional MRI scanning (EEG/fMRI) has opened up new dimensions in brain research. The simultaneous recording of EEG activity and its temparospatial haemodynamic correlates is a powerful tool in the non-invasive mapping of normal and pathological brain function. The technological constraints imposed by having a conductor (the EEG) within the magnetic environment of the MRI scanner have been sufficiently overcome for high quality EEG recording during MRI.

Typing of Borrelia relapsing fever group strains.

Partial sequencing of the 16S-23S rDNA intergenic spacer showed two to four genotypes each for Borrelia hermsii and B. turicatae, both relapsing fever agents transmitted by argasid ticks, and for B. miyamotoi and B.

Levofloxacin: update and perspectives on one of the original 'respiratory quinolones'.

The fluoroquinolone class of antimicrobials has enjoyed enormous clinical and marketing success over the past 20 years. These drugs have proven to be extremely useful in a broad range of clinical indications including both common community-acquired as well as nosocomial bacterial infections. Levofloxacin (Levaquin, Tavanic), like ciprofloxacin (Cipro), has established an enviable record of safe and efficacious use, and in many ways has become the agent against which all of the newer fluoroquinolones are judged.