ISR vs De Novo Lesion Treatment During OCT-Guided PCI: Insights From the LightLab Initiative.

Background: Long-term outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) are poor, yet limited granular procedural data exist evaluating lesion assessment, vessel treatment, and acute procedural outcomes.

Methods: The LightLab Initiative was a multicenter, prospective, observational study with contemporaneous procedural data collection during PCI procedures. Data were collected during PCIs performed by 48 interventional cardiologists at 17 US hospitals (2019-2021).

Combination biologics or targeted synthetic disease-modifying anti-rheumatic drugs in the treatment of spondyloarthritis: a systematic literature review.

Introduction: The advent of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have transformed the management of immune-mediated rheumatic diseases, including spondylarthritis (SpA). However, the data about combining b/ts DMARDs in the treatment of SpA are scarce. The study objectives were to assess the efficacy and safety of combination b/tsDMARD in SpA.

Decision-Making During Percutaneous Coronary Intervention Guided by Optical Coherence Tomography: Insights From the LightLab Initiative.

Background: Use of intracoronary imaging is associated with improved outcomes in patients undergoing percutaneous coronary intervention (PCI). Yet, the impact of intracoronary imaging on real-time physician decision-making during PCI is not fully known.

Methods: The LightLab Initiative is a multicenter, prospective, observational study designed to characterize the use of a standardized optical coherence tomography (OCT) workflow during PCI.

Effects of polysubstance exposure on neonatal outcomes for infants with intrauterine opioid exposure.

Objective: Quantify the effect of prenatal polysubstance exposure on neonatal outcomes compared to methadone exposure alone.

Study Design: This retrospective cohort study compared infants with methadone-only exposure to methadone with additional psychoactive substances. Outcomes included time to maximum Finnegan scores, proportion requiring scheduled morphine, and length of stay (LOS).

Do annuloplasty rings designed to treat ischemic/functional mitral regurgitation alter left-ventricular dimensions in the acutely ischemic ovine heart?

Objective: To quantify the effects of annuloplasty rings designed to treat ischemic/functional mitral regurgitation on left ventricular septal-lateral (S-L) and commissure-commissure (C-C) dimensions.

Methods: Radiopaque markers were placed as opposing pairs on the S-L and C-C aspects of the mitral annulus and the basal, equatorial, and apical level of the left ventricle (LV) in 30 sheep. Ten true-sized Carpentier-Edwards Physio (PHY), Edwards IMR ETlogix (ETL), and GeoForm (GEO; all from Edwards Lifesciences, Irvine, Calif) annuloplasty rings were inserted in a releasable fashion.

Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistant (MRSA) in a young healthy man.

An otherwise healthy 24-year-old man presented with 1 week of fever, facial pain and swelling. He initially sought care at an outside hospital, where he was diagnosed with folliculitis and sent home with oral antibiotics. On arrival at our institution, CT neck was ordered, which demonstrated diffuse submental phlegmon, prompting incision and drainage.

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.

Background: Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients.

Methods: We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement.

Economic impact of converting from 10-mL insulin vials to 3-mL vials and pens in a hospital setting.

Purpose: The economic impact associated with the conversion from 10-mL vials of insulin to 3-mL vials and pens at a community hospital was assessed.

Methods: Pharmacy purchasing and administrative data from Providence St. Vincent Hospital in Portland, Oregon, were used in this analysis.

Psychopharmacology training in clinical psychology: a renewed call for action.

Knowledge of psychopharmacology is essential for a clinical psychologist to practice his/her profession, regardless of whether one desires to become licensed to prescribe psychoactive medications. This commentary reiterates a call made almost 20 years ago for all practitioners to gain and utilize this knowledge. Without psychopharmacology knowledge, one is extremely limited in the ability to interact with medical prescribers and to optimally serve their patients as a valued member of the health care team.

The economic impact of minimally invasive total hip arthroplasty.

We compared hospital length of stay (LOS) and costs between (1) minimally invasive total hip surgery (MIS) combined with an active hip pathway (AHP) and (2) long incision total hip surgery (LIS) with a passive hip pathway (PHP). A prospective consecutive cohort of 214 MIS/AHP patients was compared to a concurrent cohort of 265 LIS/PHP patients. The MIS/AHP cohort had significantly decreased LOS (1.

Does the logistic EuroSCORE offer an advantage over the additive model?

There are two versions of the EuroSCORE cardiac surgery risk model for mortality: the logistic regression which provides a predicted probability of death, and an additive score, a simplified approximation to the logistic probability, which can be easily calculated without a computing aid. A recent comparison of these two models' performance concluded that the logistic probability did not offer a distinct advantage over the additive score, and that the additive score was just as accurate as the logistic probability, even in high-risk patients. This conflicts with the conclusion of our previous study of the same issue.

Eliminating the diabetic disadvantage: the Portland Diabetic Project.

The Portland Diabetic Project is an ongoing prospective study of 5534 diabetic cardiac surgery patients that elucidates the effects of hyperglycemia, and its subsequent reduction with continuous insulin infusions (CII), on in-hospital outcomes. Increasing glucose levels were found to be directly associated with increasing rates of death, deep sternal wound infections (DSWI), length of stay (LOS), and hospital costs. In separate multivariable analyses, hyperglycemia was found to be independently predictive of mortality (P < 0.

Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial.

The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data.

Effects of outcome on in-hospital transition from intravenous insulin infusion to subcutaneous therapy.

It is widely accepted by medical practitioners that diabetes is a major independent risk factor for the development of cardiovascular disease. However, less attention has been directed toward elevated blood glucose as a predictor of poor outcomes in hospitalized patients in cardiac critical care. This has occurred despite documentation of hyperglycemia in a significant proportion of patients admitted for cardiac care and considerable data supporting the use of intravenous (IV) insulin to achieve glycemic control.

The feasibility of connecting physician offices to a state-level tobacco quit line.

Background: Telephone counseling for tobacco cessation is an effective and evidence-based approach to address tobacco use. The wide dissemination of region- and state-level quit lines has been a major goal for public health agencies. However, connecting patients in primary care settings to state-level quit lines has not been evaluated.

Human endometriotic xenografts in immunodeficient RAG-2/gamma(c)KO mice.

Objective: The purpose of this study was to create a novel animal model for studies of endometriosis.

Study Design: To facilitate the study of the transplantation of endometriosis into immunodeficient RAG-2/gamma(c)KO mice, endometriosis biopsy specimens were collected from 19 women by laparoscopic surgery and grafted subcutaneously into the mice, which were treated subsequently with estradiol and progesterone to create 28-day artificial cycles. The grafts were collected during the first, second, and fourth cycles and were evaluated histologically for evidence of bleeding and immunocytochemically for estrogen receptor and progesterone receptor.

Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project.

Objective: To describe the main findings of the Portland Diabetic Project, which elucidates the adverse relationship between hyperglycemia and outcomes of cardiac surgical procedures in patients with diabetes and delineates the protective effects of intravenous insulin therapy in reducing those adverse outcomes.

Results: In this ongoing 17-year prospective, nonrandomized, interventional study of 4,864 patients with diabetes who underwent an open-heart surgical procedure, we investigated the effects of hyperglycemia, and its subsequent reduction by continuous intravenous insulin (CII) therapy, on in-hospital outcomes. Increasing blood glucose levels were found to be directly associated with increasing rates of death, deep sternal wound infections (DSWI), length of hospital stay (LOS), and hospital cost.

Collection efficiency of a single optical fiber in turbid media.

If a single optical fiber is used for both delivery and collection of light, two major factors affect the measurement of collected light: (1) the light transport in the medium that describes the amount of light that returns to the fiber and (2) the light coupling to the optical fiber that depends on the angular distribution of photons entering the fiber. We focus on the importance of the latter factor and describe how the efficiency of the coupling depends on the optical properties of the medium. For highly scattering tissues, the efficiency is well predicted by the numerical aperture (NA) of the fiber.

Argon ion beam hemostasis with albumin after liver resection.

Background: Bleeding is common after liver resection and establishing hemostasis with sutures or argon beam coagulation can be difficult. In our laboratory, concentrated albumin applied to the liver surface before argon beam coagulation improves sealing of the resected surface of the liver, including closure of blood vessels and ducts not generally seen with standard argon beam coagulation.

Methods: Domestic swine underwent heparinization, then laparotomy and wedge resection of the left medial segment of the liver, using finger fracture technique.

Inhibition of vasoconstriction by AJ-2615, a novel calcium antagonist with alpha(1)-adrenergic receptor blocking activity in human conduit arteries used as bypass grafts.

Aims: Graft spasm may develop during coronary artery bypass grafting and reversal of spasm is still challenging. The purpose of this study was to investigate the in vitro vascular relaxant properties of AJ-2615 in human internal mammary artery (IMA).

Methods: We studied 264 IMA rings taken from 65 patients undergoing coronary artery bypass grafting surgery with organ bath technique.

Inhibition of vasoconstriction by angiotensin receptor antagonist GR117289C in arterial grafts.

Background: Angiotensin II (AII) has been suggested to be one of the important factors for genesis of graft spasm in coronary artery bypass surgery. The aim of this work was to investigate the effects of the nonpeptide angiotensin receptor AT1 antagonist GR117289C on the contraction induced by AII and other vasoconstrictors in isolated human internal mammary artery (IMA) preparations.

Methods: Two hundred eight IMA rings taken from 64 patients undergoing coronary artery bypass grafting were studied in organ baths.