Obesity Is Associated With Increased Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.

Objectives: To determine the relationship between all-cause hospital mortality and morbidity in patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) and to assess whether this relationship is mediated via body mass index (BMI).

Design: Using the Extracorporeal Life Support Organization (ELSO) registry, venoarterial ECMO runs from 2015 to 2021 were retrospectively analyzed. Patient demographics, ECMO indications, and complications for survivors and decedents were univariately compared.

Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis.

Background: Tobacco use remains one of the most used substances among adults globally and substantially impacts individuals and society. Adverse childhood experiences (ACEs) contribute to tobacco use. However, the association between cumulative ACEs and tobacco use behaviors (TUB) has not been established in the literature.

Optimizing team science in an academic medical center: A qualitative examination of investigator perspectives.

Introduction: Optimizing the effectiveness of a team-based approach to unite multiple disciplines in advancing specific translational areas of research is foundational to improving clinical practice. The current study was undertaken to examine investigators' experiences of participation in transdisciplinary team science initiatives, with a focus on challenges and recommendations for improving effectiveness.

Methods: Qualitative interviews were conducted with investigators from twelve multidisciplinary teams awarded pilot research funding by the University of Kentucky College of Medicine to better understand the barriers and facilitators to effective team science within an academic medical center.

How I do it: Novel technique to "Unmask" and treat congenital portosystemic venous connections in congenital heart disease.

Congenital portosystemic venous connections are rare vascular anomalies that connect the portal and systemic venous circulations. These vascular lesions can lead to complex and varied physiologic manifestations in single-ventricle patients as they progress through the various stages of palliation in the Fontan pathway. Specifically, these connections may be unmasked after a superior cavopulmonary anastomosis operation, but then "re-masked" after Fontan completion.

Enhancing Provider Delivery of Tobacco Treatment Within the Inpatient Psychiatric Setting.

People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI.

A single arm phase II study of bone-targeted Sn-117 m-DTPA in symptomatic castration-resistant prostate cancer with skeletal metastases.

Background: Several bone-seeking radionuclides have been developed for palliation of metastatic bone pain since 1956, however, so far radium-223 dichloride is the first and only Food and Drug Administration (FDA) approved targeted alpha therapy for metastatic castration-resistant prostate cancer (mCRPC) based on ALSYMPCA phase 3 study. While radium-223 does improve pain and overall survival outcomes, the improvement can come at the expense of side effects such as bone marrow toxicity. The development of new and better treatment with long-standing pain relief is clearly an unmet medical need.

Review of Neurologic Comorbidities in Hospitalized Patients With Opioid Abuse.

Purpose Of Review: To determine the prevalence and burden of neurologic comorbidities in hospitalized patients with opioid abuse.

Recent Findings: From 1 year of hospital discharges, 2,182 patients with opioid abuse were identified (prevalence 6.3%), with abuse greater among younger patients ( < 0.

A Benzenesulfonamide-Based Mitochondrial Uncoupler Induces Endoplasmic Reticulum Stress and Immunogenic Cell Death in Epithelial Ovarian Cancer.

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancies and requires new therapeutic strategies to improve clinical outcomes. EOC metastasizes in the abdominal cavity through dissemination in the peritoneal fluid and ascites, efficiently adapt to the nutrient-deprived microenvironment, and resist current chemotherapeutic agents. Accumulating evidence suggests that mitochondrial oxidative phosphorylation is critical for the adaptation of EOC cells to this otherwise hostile microenvironment.

Making a convenient, low-cost phantom with a previously unreported material for practicing ultrasound-guided procedures.

Ultrasound-guided procedures require excellent hand-eye coordination and practice. Trainees should gain this important skill with a phantom prior to performing procedures on patients. Currently available phantoms each have their own unique limitations.

A metabolomic endotype of bioenergetic dysfunction predicts mortality in critically ill patients with acute respiratory failure.

Acute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival.

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin-induced thrombocytopenia: A systematic review.

Background: Immunomodulatory strategies in heparin-induced thrombocytopenia (HIT) include the use of intravenous immune globulin (IVIG) and therapeutic plasma exchange (TPE). The optimal application of these therapies is unknown and outcomes data are limited. We investigated treatment categories and laboratory and clinical outcomes of IVIG and/or TPE in HIT with a systematic literature review.

Robotic Arm-Assisted Total Knee Arthroplasty in the Setting of Combined Extra-articular Deformities of the Femur and Tibia.

In this case, we will describe a 68-year-old man with combined femoral and tibial bone deformities who underwent robotic arm-assisted total knee arthroplasty (RATKA) to treat his severe osteoarthritis in the setting of extra-articular deformities that altered the native anatomical axis and the kinematics of the deformed extra-articular bony structures which chronically generated a neomechanical axis. The combination of severe osteoarthritis with extra-articular deformities made the RATKA method the best surgical treatment option taking into account altered kinematics of the native joint which conventional jig-based total knee arthroplasty would not have prioritized during bony cuts and implant positioning. The patient underwent successful knee arthroplasty with robotic arm-assisted technology with restoration of the mechanical axis.

Use of Glycoprotein IIb/IIIa Inhibitors in the Modern Era of Acute Coronary Syndrome Management: A Survey of Cardiovascular Clinical Pharmacists.

Evidence for the use of glycoprotein IIb/IIIa inhibitors (GPIs) in the management of acute coronary syndrome (ACS) is from the era of either limited utilization of P2Y12 inhibitors or prior the introduction of more potent P2Y12 inhibitors. This leads to divergent opinions regarding the role of these agents in contemporary practice. This study sought the opinion of cardiovascular clinical pharmacists regarding the role of GPIs in the modern of ACS management.

Early Therapeutic Mobility and Changes in Scores for Pain and Fatigue.

This report is a secondary analysis of data from a larger study of a nurse-led early therapeutic mobility intervention among patients receiving mechanical ventilation. This analysis evaluated whether intervention frequency or intensity was associated with pain or fatigue. Frequency was defined as once-daily versus twice-daily interventions.

Patients' and Care Providers' Perceptions of Television-Based Education in the Intensive Care Unit.

Background: Delivery of patient education materials to promote health literacy is a vital component of patient-centered care, which improves patients' decision-making, reduces patients' anxiety, and improves clinical outcomes.

Objectives: To evaluate perceptions of television-based patient education among patients, caregivers, nurses, and other care providers (attending physicians, advanced practice nurses, physician assistants, and resident fellows) in the intensive care unit.

Methods: A Likert-scale survey of the perceptions of patients, caregivers, nurses, and other care providers in the medical and cardiovascular intensive care units of a large academic medical center.

Histamine drives severity of innate inflammation via histamine 4 receptor in murine experimental colitis.

Ulcerative colitis (UC) patients exhibit elevated histamine, but how histamine exacerbates disease is unclear as targeting histamine 1 receptor (H1R) or H2R is clinically ineffective. We hypothesized that histamine functioned instead through the other colon-expressed histamine receptor, H4R. In humans, UC patient biopsies exhibited increased H4R RNA and protein expression over control tissue, and immunohistochemistry showed that H4R was in proximity to immunopathogenic myeloperoxidase-positive neutrophils.

Opportunistic Pulmonary Infections in the Solid Organ Transplant Recipient: A Focus on Drug Therapy.

Immunosuppression required to prevent allograft rejection in the solid organ transplant recipient increases vulnerability to infections. Given continuous environmental exposure, the lungs are increasingly susceptible to bacterial, viral, and fungal opportunistic infections. Drug therapy options for the treatment of opportunistic pulmonary infections are used infrequently.

Maintenance Belatacept-Based Immunosuppression in Lung Transplantation Recipients Who Failed Calcineurin Inhibitors.

Background: Traditional immunosuppressive regimens (ISR) used in lung transplantation rely on calcineurin inhibitors (CNI) that occasionally cause severe adverse reactions necessitating discontinuation. Belatacept is a novel costimulation antagonist approved for use in renal transplantation which lacks data in lung transplantation. This series aims to describe the response to belatacept ISR in 11 lung transplantation recipients after CNI failure.

Central venous parathyroid hormone monitoring using a novel, specific anatomic method accurately predicts cure during minimally invasive parathyroidectomy.

Background: Measurement of intraoperative parathyroid hormone (PTH) levels is an important adjunct to confirm biochemical cure during parathyroidectomy. The purpose of this study was to evaluate a simplified anatomic technique for PTH sampling from the central veins through the minimally invasive neck incision, and to compare the predictive accuracy of central and peripheral PTH values.

Methods: A specific anatomic method for central PTH sampling was employed in 48 patients.

Dose Related Patterns of Ventricular Arrhythmia due to Carvedilol Withdrawal in Patients with Systolic Heart Failure.

Objectives: This study evaluates the impact of carvedilol dose changes on the ventricular arrhythmia event rates for patients > 18 years of age with systolic heart failure and examines dose dependent effects of carvedilol withdrawal in dose reduction and discontinuation subgroups.

Methods: This retrospective cohort study included patients with systolic heart failure (EF < 40%) receiving carvedilol. The primary outcome was incidence of ventricular arrhythmia.

Understanding risk factors, screening, and treatment of postmenopausal osteoporosis.

Between 30% and 50% of American women will endure a clinical fracture during their lifetime due to the loss of bone mineral density that occurs with menopausal estrogen loss. This article is part one in a two-part series on osteoporosis. Part two will appear in the August 2008 issue of ORTHOPEDICS.

Supplemental glucocorticoid therapy.

Supplemental glucocorticoid therapy is a topic widely debated in the medical field. Patients present with various signs, symptoms and etiologies making diagnosis of the condition elusive. There is wide inter-patient variability in cortisol response during stress so defining normal response concentrations of cortisol is difficult.

Medication and nutrient administration considerations after bariatric surgery.

Purpose: Medication and nutrient administration considerations after bariatric surgery are discussed.

Summary: Bariatric surgery is categorized by surgical technique (i.e.