Pediatric ECMO outcomes: comparison of centrifugal versus roller blood pumps using propensity score matching.

Centrifugal blood pumps are being increasingly utilized in children supported with extracorporeal membrane oxygenation (ECMO). Our aim was to determine if survival and ECMO-related morbidities in children supported with venoarterial (VA) ECMO differed by blood pump type.Children aged less than 18 years who underwent VA ECMO support from 2007 to 2009 and reported to the Extracorporeal Life Support Organization registry were propensity score matched (Greedy 1:1 matching) using pre-ECMO characteristics.

Obstruction of the superior vena cava after neonatal extracorporeal membrane oxygenation: association with chylothorax and outcome of transcatheter treatment.

Background: Obstruction of the superior vena cava is one of the potential complications of neonatal extracorporeal membrane oxygenation. Chylothorax is a known complication of surgery involving the thoracic cavity in children, and of extracorporeal membrane oxygenation. The aim of this study was to evaluate the association between chylothorax and superior vena cava obstruction after neonatal extracorporeal membrane oxygenation.

Conversion of human fibroblasts to angioblast-like progenitor cells.

Lineage conversion of one somatic cell type to another is an attractive approach for generating specific human cell types. Lineage conversion can be direct, in the absence of proliferation and multipotent progenitor generation, or indirect, by the generation of expandable multipotent progenitor states. We report the development of a reprogramming methodology in which cells transition through a plastic intermediate state, induced by brief exposure to reprogramming factors, followed by differentiation.

Characterizing peritoneal dialysis catheter use in pediatric patients after cardiac surgery.

Objective: Children who undergo cardiac surgery are at high risk for renal insufficiency and abdominal compartment syndrome. Peritoneal dialysis catheter (PDC) implantation is used in this population for abdominal decompression and access for dialysis. However, there is no consensus regarding PDC use, and the practice varies widely.

Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease.

Objective: The effect of mild acute kidney injury (AKI) on outcomes after heart surgery in children is unclear. We sought to characterize the epidemiology of mild AKI associated with surgery for congenital heart disease (CHS-AKI) in children.

Methods: We conducted a single-center, retrospective cohort study of 693 patients (aged 6 days-18 years) who underwent heart surgery in 2009.

Surgical technical performance scores are predictors of late mortality and unplanned reinterventions in infants after cardiac surgery.

Objective: We have previously shown that surgical Technical Performance Scores (TPS) are important predictors of early postoperative morbidity across a wide spectrum of procedures and that intraoperative recognition and intervention of residual defects resulted in improved outcomes. We hypothesized that these scores would also be important predictors of midterm outcomes.

Methods: Neonates and infants aged younger 6 months were prospectively followed from the index surgery for a minimum of 1 year.

Outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus roller blood pumps.

Background: Advances in centrifugal blood pump technology have led to increased use of centrifugal pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal pump ECMO.

Identification of novel markers of mouse fetal ovary development.

In contrast to the developing testis, molecular pathways driving fetal ovarian development have been difficult to characterise. To date no single master regulator of ovarian development has been identified that would be considered the female equivalent of Sry. Using a genomic approach we identified a number of novel protein-coding as well as non-coding genes that were detectable at higher levels in the ovary compared to testis during early mouse gonad development.

Cardiac medical conditions have become the leading cause of death in children with heart disease.

Objective: Mortality among children with congenital and acquired heart disease has decreased significantly over the past decades. We sought to determine whether the underlying problems leading to death in these patients had changed over the past decade.

Methods: We reviewed medical records for 100 deaths of cardiac patients in 2004-2005 and 100 deaths in 1995-1996.

Prolonged extracorporeal membrane oxygenation for children with respiratory failure.

Objective: Extracorporeal membrane oxygenation is used to support children with respiratory failure. When extracorporeal membrane oxygenation duration is prolonged, decisions regarding ongoing support are difficult as a result of limited prognostic data.

Design: Retrospective case series.

Physical therapy and rehabilitation issues for patients supported with extracorporeal membrane oxygenation.

Extracorporeal Membrane Oxygenation (ECMO) is widely used to support patients who have failed conventional therapies for cardio-respiratory failure. Patient immobility during management of critical illness and ECMO support can result in physical impairment that can lead to prolonged hospitalization and poor functional outcomes for ECMO survivors. Although little information regarding the role of physical therapy in improving functional outcomes for ECMO patients is available, early intervention with physical therapy may decrease duration of hospitalization and improve functional outcomes for patients supported with ECMO.

Identification of molecular compartments and genetic circuitry in the developing mammalian kidney.

Lengthy developmental programs generate cell diversity within an organotypic framework, enabling the later physiological actions of each organ system. Cell identity, cell diversity and cell function are determined by cell type-specific transcriptional programs; consequently, transcriptional regulatory factors are useful markers of emerging cellular complexity, and their expression patterns provide insights into the regulatory mechanisms at play. We performed a comprehensive genome-scale in situ expression screen of 921 transcriptional regulators in the developing mammalian urogenital system.

Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome.

Objective: To report the outcomes from a large multicenter cohort of neonates requiring extracorporeal membrane oxygenation (ECMO) after stage 1 palliation for hypoplastic left heart syndrome.

Methods: Using data from the Extracorporeal Life Support Organization (2000-2009), we computed the survival to hospital discharge for neonates (age ≤30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis.

Patterns of care at end of life in children with advanced heart disease.

Objective: To describe patterns of care for pediatric patients with advanced heart disease who experience in-hospital death.

Design: Retrospective single-institution medical record review.

Setting: A tertiary care pediatric hospital.

The addition of a membrane oxygenator to a ventricular assist device in a patient with acute respiratory distress syndrome.

A 12-year-old boy with Marfan's syndrome required a biventricular assist device (VAD) after an aortic root replacement. The patient developed acute respiratory distress syndrome and required escalating ventilator support. We hypothesized that the addition of a membrane oxygenator in series with the assist device would improve gas exchange and allow for a more lung-protective ventilator approach.

Ventricular assist devices for mechanical circulatory support in children.

Ventricular assist devices (VADs) are increasingly used in children to provide mechanical circulatory support as a bridge to cardiac transplantation. In this article, we review information on the current status, outcomes, and future directions for the use of VADs in children.

Quality of life of pediatric cardiac patients who previously required extracorporeal membrane oxygenation.

Objectives: We sought to assess quality of life of pediatric cardiac extracorporeal membrane oxygenation survivors. We hypothesized that these patients would have decreased quality of life when compared to that of a general U.S.

Effects of a single episode of subgingival irrigation with tetracycline HCl or chlorhexidine: A clinical and microbiological study.

Background: The present study was designed to evaluate clinical and antimicrobial effects of a single episode of subgingival tetracycline or chlorhexidine (CHX) irrigation in the absence of scaling and root planing.

Materials And Methods: Thirty patients diagnosed with chronic periodontitis were recruited for this study, each providing four non-adjacent untreated periodontal pockets with a probing depth equal to or exceeding 6 mm. The four deep periodontal pockets in each patient were assigned to be irrigated with 150 ml each of CHX digluconate 0.

Pediatric heart failure and worsening renal function: association with outcomes after heart transplantation.

Background: Renal function deteriorates in some children awaiting heart transplantation. This study was initiated to assess the effects of worsening renal function (WRF) on post-heart transplantation outcomes and to determine the effect of waiting-list associated WRF on survival after heart transplantation.

Methods: All children aged <18 years who underwent their first heart transplantation between 1999 and 2009, had reported plasma creatinine concentrations at listing and at transplantation, and were free of renal replacement therapy at listing were identified using the Organ Procurement and Transplant Network database.

Ameliorative effects of curcumin against renal injuries mediated by inducible nitric oxide synthase and nuclear factor kappa B during gentamicin-induced toxicity in Wistar rats.

The ameliorative role of curcumin in attenuating gentamicin-induced nephrotoxicity has been reported earlier however, the mechanism of action remains unclear. Gentamicin was injected intraperitoneally (100 mg/kg body weight) once daily for 6 days. Curcumin was administered orally (200 mg/kg body weight) once daily for 7, 15 and 30 days.