Comparing Sexual Network Mean Active Degree Measurement Metrics Among Men Who Have Sex With Men.

Background: Mean active degree is an important proxy measure of cross-sectional network connectivity commonly used in HIV/sexually transmitted infection epidemiology research. No current studies have compared measurement methods of mean degree using a cross-sectional study design for men who have sex with men (MSM) in the United States. We compared mean degree estimates based on reported ongoing main and casual sexual partnerships (current method) against dates of first and last sex (retrospective method).

Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky.

Background: Buprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment.

Methods: In this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices.

Time to discharge following diagnostic coronary procedures via transradial artery approach: A comparison of Terumo band and StatSeal hemostasis.

Background: The transradial artery (TRA) approach for cardiac catheterization is associated with fewer complications, earlier mobilization and a shorter stay at the hospital. The objective of this study was to determine whether hemostasis with a combination of a compression band (Terumo TR band™) and a hemostatic patch (StatSeal™) decreases the time to discharge from the hospital compared to the Terumo (TR) band alone in patients undergoing diagnostic coronary catheterizations through a TRA approach.

Methods: We retrospectively looked at 445 patients who underwent diagnostic coronary angiography through the TRA approach at the Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas between July 2016 and June 2017.

Can private, non-university-affiliated cardiothoracic training programs provide sufficient surgical experience in cardiac tumors?

Surgical case volumes in non-university-affiliated cardiothoracic surgery training programs in the US have been extensively studied by the Residency Review Committee (RRC) for thoracic surgery. The RRC has established that these programs offer a broad experience in common cardiothoracic procedures such as myocardial revascularization, valvular surgery, and cardiopulmonary transplantation. However, resident exposure to other important but less common cardiac surgical conditions in these programs remains unanswered.

Rdl gene polymorphism and sequence analysis and relation to in vivo fipronil susceptibility in strains of the cat flea.

The gamma-amino butyric acid (GABA)-gated chloride ion channel in the insect central nervous system is the target of cyclodiene and phenylpyrazole insecticides. Resistance to dieldrin has been reported in several insect species and was associated with a point mutation (Ala285 to Ser substitution) in the M2 transmembrane domain of the GABA-gated chloride ion channel (the resistant to dieldrin [Rdl] gene). A partial Rdl gene sequence was reported previously in specimens of the cat flea, Ctenocephalides felis (Bouché).

Left ventricular assist devices as permanent heart failure therapy: the price of progress.

Background Data: The REMATCH trial evaluated the efficacy and safety of long-term left ventricular assist device (LVAD) support in stage D chronic end-stage heart failure patients. Compared with optimal medical management, LVAD implantation significantly improved the survival and quality of life of these terminally ill patients. To date, however, there have been no analyses of the cost related to the LVAD survival benefit.

Revascularization in severe ventricular dysfunction (15% < OR = LVEF < OR = 30%): a comparison of bypass grafting and percutaneous intervention.

Background: We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction.

Methods: We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% < OR = LV ejection fraction < OR = 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997.

Results: The CABG group was younger (62 versus 67 years, p = 0.

Ventriculocoronary artery bypass results using a mesh-tipped device in a porcine model.

Background: In this report we describe the in vivo evaluation of a device and ventriculocoronary artery bypass procedure that creates a permanent transmyocardial channel between the left ventricle and a coronary artery.

Methods: The transmyocardial device, an L-shaped titanium tube with a meshed distal tip and an exterior polyester cuff, was implanted from the base of the left ventricle to the proximal left anterior descending coronary artery in 11 healthy juvenile domestic pigs using a beating-heart approach. Flow rates were measured at implant.

Right heart failure: best treated by avoidance.

Right heart failure continues to affect our clinical success with left ventricular assist device support. The inability to consistently predict the probability of the onset of right heart dysfunction contributes to this problem. We have developed an aggressive approach to the management of these patients in an attempt to decrease the incidence of this condition, which continues to carry a very high operative mortality.

Long-term outcome of cardiac allograft vasculopathy treated by transmyocardial laser revascularization: early rewards, late losses.

Transmyocardial laser revascularization (TLR) was initially touted as a promising therapeutic alternative for tackling the growing problem of cardiac allograft vasculopathy in late heart transplant survivors. We first described 4- and 8-week observations of application of this surgical technique, in which we professed enthusiasm for TLR in providing symptomatic relief and in reducing ischemic burden. In this report, we present the long-term (24-month) impact of TLR on clinical outcome, channel patency, and recrudescence of ischemic burden.

Minimally invasive coronary artery bypass surgery.

In the hope of decreasing patient trauma and morbidity, cardiothoracic surgeons at the Ochsner Clinic are currently investigating techniques of performing coronary bypass surgery without the use of the cardiopulmonary bypass machine, which can cause complications following surgery in patients with certain coexisting conditions (such as renovascular, cerebrovascular, or pulmonary disease), particularly elderly patients. The initial 15 at-risk patients who underwent off-pump coronary artery bypass have demonstrated extremely encouraging results in reducing previously expected complication rates. Operative and intermediate survival was 100%.

Ventricular assist device programs: design and function.

Ventricular assist device programs can be structured in a variety of models and can make use of personnel derived from a broad spectrum of clinical and hospital-based practice. When aggressively and proactively negotiated with payers, these programs can be cost-effective and thoroughly self-sustaining.

Intravenous thyroid hormone supplementation in heart failure with cardiogenic shock.

Background: Thyroid hormone level abnormalities commonly exist in severe heart failure and may be of prognostic value. The therapeutic potential of using thyroid hormone for cardiogenic shock resulting from progressive heart failure has not been previously delineated. We sought to evaluate the role of an intravenous infusion of thyroxine as an adjunct to conventional inotropic agents and intra-aortic balloon counterpulsation in patients with severe heart failure with cardiogenic shock.

Cardiac transplantation.

Cardiac transplantation has proven to be an effective and life-saving option for those patients with congestive heart failure who deteriorate despite maximal medical management. The recipients have been able to return to life as productive citizens with improved quality as well as quantity of life. Advances in assist-device technology will mean that more patients will survive until donor hearts become available and ultimately may supplement the organ supply by serving as an alternative to transplant in some patients.

The organ allocation controversy: how did we arrive here?

The Department of Health and Human Services (HHS) recently issued a final regulation governing the Organ Procurement and Transplantation Network (OPTN) that directs the allocation of organs to the sickest patients first without regard to a host of medical, geographic, and social factors that members of the transplant community view as an essential part of a sound organ allocation policy.Current organ allocation mechanisms are based on policies that reflect a broad consensus of medical experts and provide equal consideration for both the needs of the sickest patients and the efficient use of organs. This system also reduces potential waste of organs by minimizing cold ischemic time, increases access to transplantation for patients in local communities, provides positive incentives for local citizens and medical professionals to support organ donation initiatives, and decreases the cost of organ transplantation.

SXR, a novel steroid and xenobiotic-sensing nuclear receptor.

An important requirement for physiologic homeostasis is the detoxification and removal of endogenous hormones and xenobiotic compounds with biological activity. Much of the detoxification is performed by cytochrome P-450 enzymes, many of which have broad substrate specificity and are inducible by hundreds of different compounds, including steroids. The ingestion of dietary steroids and lipids induces the same enzymes; therefore, they would appear to be integrated into a coordinated metabolic pathway.

Cardiomyocyte transplantation in a porcine myocardial infarction model.

Transplantation of cardiomyocytes into the heart is a potential treatment for replacing damaged cardiac muscle. To investigate the feasibility and efficiency of this technique, either a cardiac-derived cell line (HL-1 cells), or normal fetal or neonatal pig cardiomyocytes were grafted into a porcine model of myocardial infarction. The myocardial infarction was created by the placement of an embolization coil in the distal portion of the left anterior descending artery in Yorkshire pigs (n = 9).

Effect of basic fibroblast growth factor on angiogenesis in the infarcted porcine heart.

Administration of growth factors is emerging as a new therapeutic approach for the enhancement of collateral vessel formation in the ischemic heart. We have investigated the effects of intramyocardial delivery of FGF-2 in the presence and absence of heparin on angiogenesis in a porcine model of myocardial infarction. Yorkshire pigs were subjected to myocardial infarction by the placement of an embolization coil in the left anterior descending artery (n = 5).

The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation.

Objective: The authors present their experience with patients having undergone orthotopic heart transplantation (OHT) in whom surgical conditions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported.

Summary Background Data: Several studies have evaluated the management options of biliary tract disease after OHT.

Technique of right heart protection and deairing during heartmate vented electric LVAD implantation.

Continued experience with the TCI Heartmate Ventricular Assist System has led to improvements in our ability to avoid and manage right heart dysfunction during weaning from cardiopulmonary bypass. The advent of the electric device has intensified the need for these techniques because of its elevated minimal heart rate (50 beats/min) at start-up and the demands this places on the native right heart. We have developed and here describe a technique we have used successfully in our last 8 patients to assist in deairing and filling of the ventricular assist device, to partially support the right heart during the initial wean from cardiopulmonary bypass, and to avoid occasional overdistention of the right heart during early high left ventricular assist device flow.

The risks, benefits, and costs of expanding donor criteria. A collaborative prospective three-year study.

The study purpose was to identify risks, benefits and costs associated with an expanded donor protocol. The protocol design evaluated organs rescued using expanded donor criteria and weighed all costs associated with doing so. Costs were measured against conditions experienced with expanded and traditional criteria and recipient outcome.

Myoblast transplantation in the porcine model: a potential technique for myocardial repair.

The use of transgenic cells transplanted in syngeneic rodents has shown modest success, but allogeneic and xenogeneic transplants have not been uniformly successful. To assess the feasibility of xenogeneic and allogeneic myoblast transplantation, we subjected seven adult swine to transplantation of murine atrial tumor cells (xenogeneic), neonatal porcine myocytes (allogeneic), and human fetal cardiomyocytes into the left ventricular wall. After general anesthesia, isolated cells were injected along the anterior and posterior walls of the porcine left ventricle.

Lung transplantation in Louisiana: report of the first twenty lung transplants performed in the state.

Lung transplantation is a successful alternative treatment for a variety of end-stage lung diseases. The first 20 lung transplants performed in Louisiana between November 1990 and July 1994 are reported from Ochsner Foundation Hospital. Transplant procedures included 1 heart-lung, 11 bilateral sequential lung, and 8 single-lung transplants in 8 males and 11 females (1 retransplantation).