Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States.

Obstetric sepsis is a leading cause of preventable maternal morbidity and mortality. Pregnant and postpartum patients in rural settings experience disproportionate rates of sepsis and other forms of severe maternal morbidity. Although there have been recent advances in addressing preventable morbidity and mortality from sepsis in the general adult population, combating excess rates of sepsis in the obstetric population, particularly among rural patients, will require targeted clinical and policy interventions.

Serotonin 5-HT receptors mediate the antidepressant- and anxiolytic-like effects of ventromedial prefrontal cortex deep brain stimulation in a mouse model of social defeat.

Background: Deep brain stimulation (DBS) delivered to the ventromedial prefrontal cortex (vmPFC) induces antidepressant- and anxiolytic-like responses in various animal models. Electrophysiology and neurochemical studies suggest that these effects may be dependent, at least in part, on the serotonergic system. In rodents, vmPFC DBS reduces raphe cell firing and increases serotonin (5-HT) release and the expression of serotonergic receptors in different brain regions.

Sex differences in long-term fear and anxiety-like responses in a preclinical model of PTSD.

With a high prevalence of posttraumatic stress disorder (PTSD) in females, studying sex differences in preclinical models is of substantial importance. We have previously employed behavioural criteria to identify and characterize a subpopulation of rats that presented impaired fear extinction and long-term fear and anxiety responses following fear conditioning. We now exposed male and female rats to fear conditioning and extinction and segregated the animals into weak- (WE) and strong-extinction (SE) groups based on behavioural scores during extinction.

A comparison between the HeRO graft and conventional arteriovenous grafts in hemodialysis patients.

Venous stenosis and occlusion are a major cause of vascular access dysfunction and failure. The HeRO Graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. A randomized, multicenter study was conducted to evaluate the efficacy and safety of the HeRO Graft relative to conventional AV grafts.

Multi-center experience of 164 consecutive Hemodialysis Reliable Outflow [HeRO] graft implants for hemodialysis treatment.

Objective: To report a multi-center experience with the novel Hemodialysis Reliable Outflow (HeRO) vascular access graft.

Materials And Methods: Four centers conducted a retrospective review of end stage renal disease patients who received the HeRO device from implant to last available follow-up. Data is available on 164 patients with an accumulated 2092.

Breakfast improves cognitive function in cirrhotic patients with cognitive impairment.

Background: Cognitive disturbances are relatively common in patients with liver disease. High protein load precipitates hepatic encephalopathy in cirrhotic patients. Minimal hepatic encephalopathy (MHE) is a prevalent neurocognitive complication of cirrhosis.

Initial experience and outcome of a new hemodialysis access device for catheter-dependent patients.

Objective: The effects of a new long-term subcutaneous vascular access device were studied in access-challenged patients who were poor candidates for fistulas or grafts due to venous obstruction. Bacteremia rates, patency, and function of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device (Hemosphere Inc, Minneapolis, Minn) were evaluated.

Methods: The HeRO device consists of a 6-mm expanded polytetrafluoroethylene graft attached to a 5-mm nitinol-reinforced silicone outflow component designed to bypass venous stenoses and enter the internal jugular vein directly, providing continuous arterial blood flow into the right atrium.

Challenges of hemodialysis access for high risk patients: Impact of mesenteric vein bioprosthetic graft.

Objective: The purpose of this study is to compare in a prospective fashion the performance of a new bioprosthesis, the mesenteric vein bioprosthesis (MVB), in patients who have had multiple failed ePTFE grafts. Performance measures include primary patency rates, assisted-primary patency rates, secondary patency rates, complications, and the number of interventions required to maintain graft patency.

Study: From October 1999 to February 2002, 276 hemodialysis access grafts were implanted in a multicenter study.

Retrograde migration of an abdominal aortic aneurysm endograft leading to postoperative renal failure.

The phenomenon of antegrade (distal) endograft migration is an extensively documented complication after endovascular abdominal aortic aneurysm repair. This case report describes the finding of postoperative abdominal aortic aneurysm endograft retrograde (proximal) migration occluding bilateral renal arteries and leading to dialysis-dependent renal failure.

Multicenter evaluation of the bovine mesenteric vein bioprostheses for hemodialysis access in patients with an earlier failed prosthetic graft.

Background: The number of patients requiring hemodialysis increases each year, with a large cohort of patients still requiring prosthetic grafts for hemodialysis. All available prosthetic vascular access grafts have predictable failure rates, leading to a large group of patients with multiple failed access grafts. This report evaluates use of mesenteric vein bioprosthesis (MVB) as a conduit for patients who have failed at least one earlier synthetic vascular access graft.

Alternative graft materials for hemodialysis access.

Since the initial description of the arteriovenous (AV) fistula, autogenous access has been the procedure of choice for chronic hemodialysis. Recently established National Kidney Foundation Dialysis Outcome and Quality Initiative guidelines have validated the superiority of arteriovenous fistulas over AV grafts but have also addressed the fact that a significant percentage of the growing dialysis population does not have veins suitable for primary AV fistulas. Recent advances in forearm, upper arm, and femoral venous transpositions have facilitated the performance of increased numbers of autogenous access procedures.

Risk stratification and outcomes of transluminal endografting for abdominal aortic aneurysm: 7-year experience and long-term follow-up.

Purpose: To determine early and late outcomes of transluminal endografting (TE) in patients with abdominal aortic aneurysm (AAA), stratified by predicted risk of procedure-related mortality with conventional operation.

Materials And Methods: A retrospective study was conducted in consecutive risk-stratified AAA patients undergoing TE at a not-for-profit cardiovascular referral center from March 1994 through November 2000 with follow-up through February 2001. With use of conventional risk strata (0 = low, 1 = minimal, 2 = moderate, and 3 = high), predicted procedure-related mortalities were 0%-1% in stratum 0 (n = 40), 1%-3% in stratum 1 (n = 118), 3%-8% in stratum 2 (n = 116), and 8%-30% in stratum 3 (n = 31).

Community pharmacist interventions in a capitated pharmacy benefit contract.

Documented interventions associated with processing prescriptions in a managed care environment were analyzed, and a bench-mark for interventions was proposed. A retrospective analysis of documented interventions by 31 pharmacies contracted by a managed care organization to serve 22,000 Medi-Cal patients was undertaken. An intervention consisted of identifying any problem related to a prescription, taking action, and recording the problem, action, and outcome on a form.

Bile duct varices.

The diagnosis of biliary duct varices and portal vein occlusion should be considered when nodular or notched defects in the wall of the biliary duct system are shown by cholangiography or when pedunculated vascular structures in the bile ducts are seen at surgery. We present two cases of common hepatic and common bile duct varices due to portal vein occlusion.

Bovine artegraft arteriovenous fistulas for hemodialysis in one-hundred patients after "conventional" arteriovenous fistulas failed.

The use of the Bovine artegraft for creation of arteriovenous fistulas in the hemodialysis patients was first carried out in the midsummer of 1971. Since that time, there has been considerable material reported in the use of this substitute as an access for hemodialysis. In this article information gained from an ongoing study of the first 100 patients in chronic hemodialysis who had Bovine artegraft arteriovenous fistulas was reviewed.

Three year experience with bovine graft arteriovenous (A-V) fistulas in 100 patients.

On the basis of the preceding discussion and information, it is our conclusion that: 1. Bovine graft A-V fistuals can be created successfully in 87% of those patients who have had a failure of conventional fistuals. 2.

Sintered diamond compacts with a cobalt binder.

Diamond powder can be successfully cemented with cobalt. At 62 kilobars the sintering occurs over the temperature range from 1570 degrees to 1610 degrees C. The maximum microhardness of the compact ( 3000 kilograms per square millimeter on the Knoop scale) is obtained with a mixture of 20 percent cobalt (by volume) and a diamond particle size of 1 to 5 micrometers.