The role of fetal hemoglobin in the artificial placenta: A premature ovine model.

Introduction: A radical paradigm shift in the treatment of premature infants failing conventional treatment is to recreate fetal physiology using an extracorporeal Artificial Placenta (AP). The aim of this study is to evaluate the effects of changing fetal hemoglobin percent (HbF%) on physiology and circuit function during AP support in an ovine model.

Methods: Extremely premature lambs ( = 5) were delivered by cesarean section at 117-121 d estimated gestational age (EGA) (term = 145d), weighing 2.

Realizing new designs of multiplexed electrode chips by 3-D printed masks.

Creating small and portable analytical methods is a fast-growing field of research. Devices capable of performing bio-analytical detection are especially desirable with the onset of the global pandemic. Lab-on-a-chip (LOC) technologies, including rapid point-of-care (POC) devices such as glucose sensors, are attractive for applications in resource-poor settings.

Hepatic Function in Premature Lambs Supported by the Artificial Placenta and Total Parenteral Nutrition.

The artificial placenta (AP) promotes organ development and reduces organ injury in a lamb model of extreme prematurity. This study evaluates hepatic outcomes after AP support with total parenteral nutrition (TPN) administration. Premature lambs (116-121 days estimated gestational age; term = 145) were cannulated for 7 days of AP support.

Geographic variation in the use of continuous outpatient inotrope infusion therapy and beta blockers.

Background: Continuous outpatient inotrope infusion therapy (COIIT) can be used as palliative or interim treatment in patients with advanced heart failure (AHF). Despite widespread use, there is a relative lack of data informing best practices. This study aimed to examine whether patterns of COIIT use differed by region and to explore whether observed differences influenced clinical outcomes.

N-Heterocyclic carbenes meet toll-like receptors.

Combining the stability of the N-heterocyclic carbenes (NHCs) and broad-spectrum recognition of toll-like receptor (TLR) proteins, we report new electrochemical biosensors for bacteria detection. Instead of traditional thiol-gold chemistry, newly synthesized NHCs are employed as the linker molecules to immobilize TLR bio-recognition elements on gold electrodes. Our proof-of-concept methodology includes testing the fidelity of TLR-based electrochemical sensors with NHC linkers.

Acute pulmonary pressure change after transition to sacubitril/valsartan in patients with heart failure reduced ejection fraction.

Aims: Sacubitril/valsartan combines renin-angiotensin-aldosterone system inhibition with amplification of natriuretic peptides. In addition to well-described effects, natriuretic peptides exert direct effects on pulmonary vasculature. The effect of sacubitril/valsartan on pulmonary artery pressure (PAP) has not been fully defined.

Developing a toll-like receptor biosensor for Gram-positive bacterial detection and its storage strategies.

The biorecognition ability of hybridized toll-like receptors (TLRs) 2 and 6 proteins on electrode surfaces has been studied. TLR biosensors have been designed to be non-specific to particular bacterial strains but rather to provide broad spectrum detection of cells and toxins containing relevant pathogen-associated molecular patterns (PAMPs). Our electrochemical TLR2/6 biosensors demonstrated selective detection towards Gram-positive bacterial whole-cells and a synthetic diacylated lipopeptide (Pam2CSK4), a PAMP.

Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA: A case series.

Introduction: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA).

Methods: A total of 2253 inpatients underwent colonoscopy.

Comparing mortality risk models in VLBW and preterm infants: systematic review and meta-analysis.

Objective: To compare the prognostic accuracy of six neonatal illness severity scores (CRIB, CRIB II, SNAP, SNAP II, SNAP-PE, and SNAP-PE II), birthweight (BW), and gestational age (GA) for predicting pre-discharge mortality among very low birth weight (VLBW) infants (<1500 g) and very preterm infants (<32 weeks' gestational age).

Study Design: PubMed, EMBASE, and Scopus were the data sources searched for studies published before January 2019. Data were extracted, pooled, and analyzed using random-effects models and reported as AUC with 95% confidence intervals (CI).

Circumstances surrounding gun violence with youths in an urban setting.

Background: Our pediatric trauma center has noted an increase in the occurrence of gunshot wounds in children. We aimed to understand the circumstances surrounding these injuries in order to provide targeted injury prevention methodologies.

Methods: A retrospective review was performed on patients who presented with a gunshot wound to our Level I Pediatric Trauma Center and two neighboring Adult Trauma Centers between 2013 and 2017.

Multimodality Imaging of Danon Disease in a Patient with a Novel Mutation.

• Danon disease is a rare X-linked genetic disorder of the gene. • Danon cardiomyopathy has a high incidence of preexcitation and severe LVH. • mutation–associated cardiomyopathy can mimic sarcomeric HCM.

Ex Vivo Heart Perfusion for 72 Hours Using Plasma Cross Circulation.

Preservation of a donor heart for transplantation is limited to 6-8 hours. Based on our demonstration of 12 hour perfusion with plasma cross circulation, this study aimed to evaluate ex vivo heart perfusion (EVHP) for up to 72 hours using cross plasma circulation (XC-plasma) from a live, awake paracorporeal sheep (PCS). Six ovine hearts were perfused for 72 hours using plasma cross circulation at a rate of 1 L/min with a live, awake PCS.

A Model of Pediatric End-Stage Lung Failure in Small Lambs <20 kg.

One in five children with end-stage lung failure (ESLF) die while awaiting lung transplant. No suitable animal model of ESLF exists for the development of artificial lung devices for bridging to transplant. Small lambs weighing 15.

Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction.

Background: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception.

Materials And Methods: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms.

Splenic development and injury in premature lambs supported by the artificial placenta.

Introduction: The purpose of this study is to evaluate splenic effects during artificial placenta (AP) support.

Methods: AP lambs (118-121 d, n = 14) were delivered and placed on the AP support for a goal of 10-14 days. Cannulation used right jugular drainage and umbilical vein reinfusion.

Can fecal continence be predicted in patients born with anorectal malformations?

Purpose: The purpose of this study was to identify factors associated with attaining fecal continence in children with anorectal malformations (ARM).

Methods: We performed a multi-institutional cohort study of children born with ARM in 2007-2011 who had spinal and sacral imaging. Questions from the Baylor Social Continence Scale were used to assess fecal continence at the age of ≥4 years.

An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery.

Purpose: We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery.

Study Design: Initial studies compared the LigaSure Impact and Harmonic ACE + 7 Shears in the efficiency of hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term = 145;  = 7) underwent hysterotomy using either device.

Gastrointestinal mucosal development and injury in premature lambs supported by the artificial placenta.

Background: An Artificial Placenta (AP) utilizing extracorporeal life support (ECLS) could revolutionize care of extremely premature newborns, but its effects on gastrointestinal morphology and injury need investigation.

Methods: Lambs (116-121days GA, term=145; n=5) were delivered by C-section, cannulated for ECLS, had total parenteral nutrition (TPN) provided, and were supported for 7days before euthanasia. Early and Late Tissue Controls (ETC, n=5 and LTC, n=5) delivered at 115-121days and 125-131days, respectively, were immediately sacrificed.

Perfluorocarbons Prevent Lung Injury and Promote Development during Artificial Placenta Support in Extremely Premature Lambs.

Background: Extremely premature neonates suffer high morbidity and mortality. An artificial placenta (AP) using extracorporeal life support (ECLS) is a promising therapy.

Objectives: We hypothesized that intratracheal perfluorocarbon (PFC) instillation during AP support would reduce lung injury and promote lung development relative to intratracheal amniotic fluid or crystalloid.

Interprofessional education day - an evaluation of an introductory experience for first-year students.

Interprofessional health care teams have been shown to improve patient safety and reduce medical errors, among other benefits. Introducing interprofessional concepts to students in full day events is an established model that allows students to learn together. Our group developed an academic day for first-year students devoted to an introductory interprofessional education (IPE) experience, 'IPE Day'.

Outcomes of Adolescent and Young Adults Receiving High Ligation and Mesh Repairs: A 16-Year Experience.

Introduction: Interestingly, the pediatric and adult surgeons perform vastly different operations in similar patient populations. Little is known about long-term recurrence and quality of life (QOL) in adolescents and young adults undergoing inguinal hernia repair. We evaluated long-term patient-centered outcomes in this population to determine the optimal operative approach.

Cerebral Oxygenation of Premature Lambs Supported by an Artificial Placenta.

An artificial placenta (AP) using venovenous extracorporeal life support (VV-ECLS) could represent a paradigm shift in the treatment of extremely premature infants. However, AP support could potentially alter cerebral oxygen delivery. We assessed cerebral perfusion in fetal lambs on AP support using near-infrared spectroscopy (NIRS) and carotid arterial flow (CAF).