Interhospital Variability in 180-day Infections Following Cardiac Surgery.

Objective: This study sought to: (1) evaluate hospital-level variation in infections following cardiac surgery and (2) develop and evaluate a 180-day infection quality metric.

Methods: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was an infection within 180 days of surgery.

A Nationwide Evaluation of Cardiothoracic Resident Research Productivity.

Background: Evaluating the research productivity of cardiothoracic surgery residents during their training and early career is crucial for tracking their academic development. To this end, the training pathway of residents and the characteristics of their program in relation to their productivity were evaluated.

Methods: Alumni lists from integrated 6-year thoracic surgery (I-6) and traditional thoracic surgery residency programs were collected.

Oxygen Delivery Thresholds During Cardiopulmonary Bypass and Risk for Acute Kidney Injury.

Background: Postoperative acute kidney injury (AKI) in cardiac surgery patients is multifactorial and associated with low oxygen delivery (DO) during cardiopulmonary bypass.

Methods: Cardiac surgical patients undergoing full cardiopulmonary bypass between May 1, 2016 and December 31, 2021 were included, whereas those on preoperative dialysis, undergoing circulatory arrest procedures, or lacking minute-to-minute physiologic data were excluded. A 5-minute running average of indexed DO (DOi, mL/min/m) was calculated ([pump flow] × [hemoglobin] × 1.

Adult Clinical Perfusion Practice Survey: 2020 results.

: Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced. Despite the emergence of evidence-based clinical practice guidelines, little is known about their dissemination at the institutional level. Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment, techniques, and staffing.

Keratoacanthoma centrifugum marginatum.

Keratoacanthoma centrifugum marginatum (KCM) is an uncommon variant of keratoacanthoma. Keratoacanthoma centrifugum marginatums are most commonly seen on sun-exposed surfaces and present with progressive peripheral expansion and raised, hyperkeratotic borders. Central clearing with atrophy and lack of spontaneous clearance are other key clinical characteristics.

Pedunculated atypical fibroxanthomas of the face.

Atypical fibroxanthomas are rare, superficial dermal tumors. Most cases are benign and only locally destructive with a low rate of metastasis. Lesions are most commonly found on sun-exposed sites of elderly light-skinned patients and present as asymptomatic nodules with irregular borders; ulcerations and friability are other key characteristics.

The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis.

Background: Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center.

Pyoderma gangrenosum: a presenting sign of myelodysplastic syndrome in undiagnosed Fanconi anemia.

A 26-year-old man with a history of congenital bilateral microtia, unilateral renal agenesis, left aural atresia, and right external auditory canal occlusion admitted for right rib cartilage graft harvest and left ear re-construction. Following surgery, an ulceration with violaceous borders and a yellow fibrinous base unresponsive to broad-spectrum antibiotics developed at the harvest site. The wound was expanding and not responsive to systemic broad-spectrum antibiotics.

Is Nocturnal Extubation After Cardiac Surgery Associated With Worse Outcomes?

Background: There is an increased risk of medical errors overnight compared with the day, secondary to fatigue, paucity of resources, and decreased staffing. Whether this increased risk extends to liberation from mechanical ventilation is controversial. We evaluated the relationship between length of intubation and differences between diurnal and nocturnal extubation.

Building a Targeted Asthma Education and Management Program.

For individuals with asthma, self-management at home can be complex and overwhelming. The National Asthma Guidelines recommend education, ongoing assessment of control, and identification of those at high risk, as integral elements of improving outcomes for these individuals. Children's Mercy implemented standardized, patient-centered asthma education interventions along with institution of asthma control assessment tools and targeted management of high risk asthmatics.

The natural history of chronic actinic dermatitis: an analysis at a single institution in the United States.

Background: Chronic actinic dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of chronic actinic dermatitis occurs over time in most patients. However, the natural history of chronic actinic dermatitis in patients in the United States has not been studied.

Methotrexate in the treatment of pemphigus vulgaris: experience in 23 patients.

Background: The standard treatment for patients with pemphigus vulgaris has long consisted of high-dose glucocorticoids. Studies regarding the use of methotrexate in pemphigus vulgaris date back to 1968, but few have quantitatively described a steroid-sparing effect conferred by methotrexate.

Objectives: We sought to evaluate the efficacy of methotrexate in 23 patients with pemphigus vulgaris, using the drug's steroid-sparing effect as the primary indicator of clinical improvement.

Fentichlor photocontact dermatitis: a persistent enigma.

Background: Fentichlor elicits high rates of positive photopatch test reactions despite its currently unknown clinical relevance.

Objectives: The aims of this study were to provide a comprehensive review of fentichlor, to investigate the characteristics of patients with photosensitivity to fentichlor, and to explore the current uses of fentichlor.

Methods: A review of photopatch test studies involving fentichlor was performed.

Epidermal platelet-activating factor receptor activation and ultraviolet B radiation result in synergistic tumor necrosis factor-alpha production.

Ultraviolet B radiation (UVB) is a potent stimulator of epidermal cytokine production which has been implicated in photoaggravated dermatoses. In addition to cytokines such as tumor necrosis factor-alpha (TNF-alpha), UVB generates bioactive lipids including platelet-activating factor (PAF). Our previous studies have demonstrated that UVB-mediated production of keratinocyte TNF-alpha is in part due to PAF.

Ultraviolet B radiation generated platelet-activating factor receptor agonist formation involves EGF-R-mediated reactive oxygen species.

Recent studies have implicated the lipid mediator platelet-activating factor (PAF) in UVB-mediated systemic immunosuppression known to be a major cause for skin cancers. Previously, our group has demonstrated that UVB irradiation triggers the production of PAF and oxidized glycerophosphocholines that act as PAF-receptor (PAF-R) agonists. The present studies explored the mechanisms by which UVB generates PAF-R agonists.

Intermittent exposure of medulloblastoma cells to topotecan produces growth inhibition equivalent to continuous exposure.

Camptothecin analogues such as topotecan increase the number of covalent topoisomerase I-DNA complexes, which, in turn, have been proposed to initiate apoptosis. If induction of apoptosis by the camptothecins is, in fact, dependent on the formation of topoisomerase I-DNA complexes, then it would be of clinical relevance to identify schedules of exposure to the camptothecins that maximize the formation of these complexes but minimize the total amount of the drug administered. The time and dose dependence of topoisomerase I-DNA complex formation was determined by incubating Daoy pediatric medulloblastoma cells in vitro with topotecan at concentrations equivalent to those achievable in the plasma clinically (10, 50, or 200 nM) and measuring the number of complexes present in cells incubated for 15 min to 48 h with the drug.

Cellular localization domains of a rabbit and a human carboxylesterase: influence on irinotecan (CPT-11) metabolism by the rabbit enzyme.

Enzyme activation of prodrugs to improve the therapeutic index of specific anticancer agents is an attractive alternative to current chemotherapy regimens. This study addresses the potential for activating irinotecan (CPT-11) with recombinant carboxylesterases (CEs). CEs are a ubiquitous class of enzymes thought to be involved in the detoxification of xenobiotics.

In situ subcellular localization of epitope-tagged human and rabbit carboxylesterases.

Carboxylesterases are a ubiquitous class of enzymes thought to be involved in xenobiotic metabolism and detoxification. Primary amino acid sequence data suggest that these proteins localize to the endoplasmic reticulum. However, since this family of proteins is highly homologous, the generation of specific reagents to monitor expression and subcellular localization has been unsuccessful.