Rotors as drivers of atrial fibrillation and targets for ablation.

Atrial fibrillation (AF) is the most common arrhythmia targeted by catheter ablation. Despite significant advances in our understanding of AF, ablation outcomes remain suboptimal, and this is due in large part to an incomplete understanding of the underlying sustaining mechanisms of AF. Recent developments of patient-tailored and physiology-based computational mapping systems have identified localized electrical spiral waves, or rotors, and focal sources as mechanisms that may represent novel targets for therapy.

RADPEER peer review: relevance, use, concerns, challenges, and direction forward.

RADPEER is a product developed by the ACR that aims to assist radiologists with quality assessment and improvement through peer review. The program opened in 2002, was initially offered to physician groups in 2003, developed an electronic version in 2005 (eRADPEER), revised the scoring system in 2009, and first surveyed the RADPEER membership in 2010. In 2012, a survey was sent to 16,000 ACR member radiologists, both users and nonusers of RADPEER, with the goal of understanding how to make RADPEER more relevant to its members.

Effect of fluconazole prophylaxis on candidiasis and mortality in premature infants: a randomized clinical trial.

Importance: Invasive candidiasis in premature infants causes death and neurodevelopmental impairment. Fluconazole prophylaxis reduces candidiasis, but its effect on mortality and the safety of fluconazole are unknown.

Objective: To evaluate the efficacy and safety of fluconazole in preventing death or invasive candidiasis in extremely low-birth-weight infants.

Role of interventional radiology in the management of acute gastrointestinal bleeding.

Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology.

High-fidelity simulation training in advanced resuscitation for pharmacy residents.

Objective: To assess the impact of high-fidelity patient simulation on pharmacy resident knowledge, confidence, and competency with advanced resuscitation algorithms and interventions.

Design: An overview of the institutional cardiopulmonary arrest algorithm and a review of pertinent medications and calculations were presented to postgraduate year 1 (PGY1) pharmacy residents, followed by participation in 3 simulated clinical scenarios using a high-fidelity mannequin.

Assessment: An improvement of pharmacy resident knowledge, confidence, and competency with advanced resuscitation skills was observed.

Plasma vasopressin levels in patients with right-sided heart dysfunction and chronic thromboembolic pulmonary hypertension (CTEPH).

Objectives: Patients with left-sided heart dysfunction and volume overload often have associated elevations in vasopressin from neuroendocrine activation. The authors investigated perioperative levels of vasopressin in patients with isolated right-sided heart dysfunction from chronic thromboembolic pulmonary hypertension.

Design: Prospective, observational study.

Peritoneal dialysis prescription during the third trimester of pregnancy.

Management of the pregnant patient on peritoneal dialysis (PD) is potentially challenging because uterine enlargement may negatively affect catheter function and prescribed dwell volumes. Additional reports of the management of these patients are needed. Here, we describe a near-full-term delivery in a 27-year-old woman who had been on dialysis for 7 years.

The multifaceted effects of polysaccharides isolated from Dendrobium huoshanense on immune functions with the induction of interleukin-1 receptor antagonist (IL-1ra) in monocytes.

Dendrobium huoshanense is a valuable and versatile Chinese herbal medicine with the anecdotal claims of cancer prevention and anti-inflammation. However, its immunological activities are limited to in vitro studies on a few cytokines and immune cell functions. First, we investigated the effects of polysaccharides isolated from DH (DH-PS) on inducing a panel of cytokines/chemokines in mice in vivo and human in vitro.

Impact of a third-year surgical apprenticeship model: perceptions and attitudes compared with the traditional medical student clerkship experience.

Background: Current literature suggests that medical students may have negative misconceptions of a surgical career partly due to the traditional hierarchical structure of the surgical clerkship. We hypothesized that a novel medical student apprenticeship would result in positive changes in perceptions of both surgeons and surgical careers.

Study Design: In the 2011 academic year, third-year medical students were offered a 2-week apprenticeship elective, in addition to the standard 8-week surgical clerkship.

Fluorescent angiogenesis models using gelfoam® implanted in transgenic mice expressing fluorescent proteins.

Fidler's group described an in vivo angiogenesis assay utilizing Gelfoam(®) sponges impregnated with agarose and proangiogenic factors. Vessels were detected by staining with fluorescent antibodies against CD31. We showed that Gelfoam(®) implanted in transgenic mice expressing the nestin promoter-driven green fluorescent protein (ND-GFP mice) was rapidly vascularized with ND-GFP-expressing nascent blood vessels.

Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons.

The efficacy of highly active antiretroviral therapy (HAART) is dependent upon moderately high levels of adherence; however, predicting adherence before HAART initiation can be difficult. We conducted a prospective, longitudinal study among 350 HIV-infected adults attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011 to examine both established and novel predictors of adherence, including religious practices and beliefs. Statistically significant (p < .

The impact of patient telephone call after discharge on likelihood to recommend in an academic emergency department.

Background: Patient satisfaction is a common parameter tracked by health care systems, and likely influences patient provider choice and may impact insurer payment. Achieving high satisfaction in an academic emergency department (ED) can be a daunting task due to variable volumes, acuity, and overcrowding.

Objective: The objective of this study was to assess the impact of a postdischarge telephone call by a staff member after discharge from the ED on patient satisfaction.

Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism.

Purpose: The implementation of best practices to optimize inpatient anticoagulation and venous thromboembolism (VTE) management are described.

Summary: A multidisciplinary team of pharmacists, hospitalists, computer prescriber-order-entry system (CPOE) experts, and data specialists was assembled. A VTE management best-practices bundle was designed and implemented using education, CPOE upgrades, clinical decision support, triggered consultation, and checklists.

Cause-specific effects of radiotherapy and lymphadenectomy in stage I-II endometrial cancer: a population-based study.

Background: Radiotherapy and lymphadenectomy have been associated with improved survival in population-based studies of endometrial cancer, which is in contrast with findings from randomized trials and meta-analyses. The primary study aim was to estimate the cause-specific effects of adjuvant radiotherapy and lymphadenectomy on competing causes of mortality.

Methods: We analyzed Surveillance, Epidemiology, and End Results (SEER) data from 1988 to 2006.

Magnetic resonance imaging for intratesticular and extratesticular scrotal lesions.

Introduction: To evaluate magnetic resonance imaging (MRI) utility in intratesticular and extratesticular scrotal diseases.

Materials And Methods: Two radiologists retrospectively reviewed images of patients who underwent ultrasound followed by MRI, categorizing them as intratesticular or extratesticular and malignant, benign, indeterminate, or inadequate study. For patients who underwent surgical excision, pathologic results were also correlated to the presurgical ultrasound and MRI diagnoses.

Mid-region pro-adrenomedullin adds predictive value to clinical predictors and Framingham risk score for long-term mortality in stable outpatients with heart failure.

Aims: The aim of this study was to evaluate the long-term prognostic utility of mid-region prohormone adrenomedullin (MR-proADM) in stable outpatients with heart failure (HF).

Methods And Results: Echocardiogram and serum for MR-proADM and BNP levels were obtained in 724 stable outpatients. These patients were followed for up to 6 years for the primary endpoint of all-cause mortality.

Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment.

Paralleling the growing popularity of organized sports among pediatric athletes, the stress and intensity of training regimens has escalated the frequency and severity of pediatric overuse injuries. It is essential that radiologists have a thorough knowledge of the pathogenesis of these injuries and of their characteristic patterns with different imaging techniques in order to appropriately diagnose overuse injuries in the pediatric skeleton. Knowledge of the classification, mechanism, clinical and imaging manifestations of acute and chronic overuse injuries of the lower extremities common among pediatric athletes can assist in imaging-based diagnosis and characterization of injury.

Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress.

Background: The use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described.

Objectives: The purpose of this study was to measure the efficacy of adding pre-hospital CPAP to an urban emergency medical service (EMS) respiratory distress protocol on persons with respiratory distress.

Methods: A historical cohort analysis of consecutive patients between 2005 and 2010.

Modalities of treatment for laryngotracheal stenosis: the EVMS experience.

Objectives/hypothesis: The aims of the study were to identify trends in surgical management of laryngotracheal stenosis (LTS) based on lesion location, as well as to recognize factors associated with recurrence and repeat surgical intervention.

Study Design: The study is a retrospective review of all adult patients cared for at a tertiary care laryngology practice with a diagnosis of laryngotracheal stenosis between October 2001 and July 2010, following Institutional Review Board approval.

Methods: This study collectively measured demographics, comorbidities, etiologies, sites of stenoses, treatment modalities, and recurrences.

Comparison of cardiovascular and biomechanical parameters of supine lower body negative pressure and upright lower body positive pressure to simulate activity in 1/6 G and 3/8 G.

For future space exploration missions, it is important to determine the best method of simulating on Earth cardiovascular and biomechanical conditions for lunar and Martian gravities. For this purpose, we compared exercise performed within a lower body negative pressure (LBNP) and a lower body positive pressure (LBPP) chamber. Twelve subjects underwent a protocol of resting and walking (0.

Percutaneous nephrolithotomy use is increasing in the United States: an analysis of trends and complications.

Purpose: To report the use and complication rates of percutaneous nephrolithotomy (PCNL) performed in the United States between 1998 and 2009.

Patients And Methods: The Nationwide Inpatient Sample database was analyzed from 1998 to 2009 to identify all PCNL cases performed in adults ≥18 years old. Descriptive statistics were used for potential covariates: Demographics, comorbidities, academic/community hospital, rural/urban location, and U.

The selective therapeutic apheresis procedures.

Selective apheresis procedures have been developed to target specific molecules, antibodies, or cellular elements in a variety of diseases. The advantage of the selective apheresis procedures over conventional therapeutic plasmapheresis is preservation of other essential plasma components such as albumin, immunoglobulins, and clotting factors. These procedures are more commonly employed in Europe and Japan, and few are available in the USA.

Achieving targeted pulse oximetry values in preterm infants in the delivery room.

Objective: To determine whether resuscitation teams can better maintain newborn transitional oxygen saturation (SpO₂) values within a prespecified target range using a graphical display of the targets and real-time SpO₂ data compared with using only numerical oximeter values.

Study Design: Preterm neonates were enrolled in this prospective cohort evaluation of a change in practice. The Transitional Oxygen Targeting System (TOTS) plots real-time SpO₂ values in relation to 10th and 50th percentile SpO₂ curves, which provides a visual target.

Malignancies of the spinal cord.

The management of intramedullary spinal cord tumors (IMSCT) is primarily concerned with the preservation of existing neurologic function. To this end, clinical scientists are continually seeking tools and techniques to improve the safety and efficacy of tumor resection and control. Further advances in safety and efficacy can be proposed at each phase of management, from pre-operative screening to post-treatment monitoring.

Informatics in Radiology: developing a touchless user interface for intraoperative image control during interventional radiology procedures.

Review of prior and real-time patient images is critical during an interventional radiology procedure; however, it often poses the challenge of efficiently reviewing images while maintaining a sterile field. Although interventional radiologists can "scrub out" of the procedure, use sterile console covers, or verbally relay directions to an assistant, the ability of the interventionalist to directly control the images without having to touch the console could offer potential gains in terms of sterility, procedure efficiency, and radiation reduction. The authors investigated a potential solution with a low-cost, touch-free motion-tracking device that was originally designed as a video game controller.