Lapse of care as a predictor for morbidity in adults with congenital heart disease.

Background: There is a need for timely transition of patients with congenital heart disease who have reached adulthood. While the American Heart Association guidelines dictate that patients with moderate or great complexity lesions be seen at least every 2 years, lapse in care is common. We sought to assess the frequency and clinical impact of lapse of medical care in adults with moderate or great complexity cardiac lesions diagnosed in childhood.

Content Among Locally Approved HIPAA Authorization forms for Research.

THIS STUDY WAS DESIGNED TO ASSESS differences in the content of HIPAA authorization forms now required for clinical research. Authorization forms were collected from 111 institutions, including academic medical centers and commercial Institutional Review Boards. The requirement for an element covering the use of information acquired was fulfilled in 95% of the forms, and 100% had a statement fulfilling the core requirement of a description of the data to be collected.

Analysis of strategies to improve cost effectiveness of blood cultures.

Background: Approximately 90% of all blood cultures grow no organisms (ie, are true negatives), and 5% are thought to represent contaminants (ie, are false positives). The cost effectiveness of blood cultures could therefore be improved by developing rules that safely decreased the number of cultures drawn from patients with a low likelihood of having bacteremia and/or by improving the process of obtaining cultures, thereby decreasing the number of contaminants. We analyzed the potential effects of these two approaches.

Ndfip1 protein promotes the function of itch ubiquitin ligase to prevent T cell activation and T helper 2 cell-mediated inflammation.

Nedd4 family interacting protein-1 (Ndfip1) is a protein whose only known function is that it binds Nedd4, a HECT-type E3 ubiquitin ligase. Here we show that mice lacking Ndfip1 developed severe inflammation of the skin and lung and died prematurely. This condition was due to a defect in Ndfip1(-/-) T cells.

Bioactivity of postshock mesenteric lymph depends on the depth and duration of hemorrhagic shock.

Mesenteric hypoperfusion due to circulatory shock is a key event in the pathogenesis of subsequent distant organ injury. Postshock mesenteric lymph (PSML) has been shown to contain proinflammatory mediators elaborated from the ischemic gut. We hypothesize that the relative bioactivity of PSML depends on the depth and duration of circulatory shock.

Endovascular repair of a large post-traumatic calf pseudoaneurysm and arteriovenous fistula.

Endovascular techniques are being increasingly used as the definitive method of repair for various traumatic vascular injuries. This case report describes the use of transcatheter embolization and direct percutaneous thrombin injection used in the definitive treatment of a lower extremity posttraumatic pseudoaneurysm and arteriovenous fistula.

Regional fibroblast heterogeneity in the lung: implications for remodeling.

Rationale: Excessive deposition of extracellular matrix occurs in proximal airways of individuals with asthma, but fibrosis in distal lung has not been observed. Whether differing fibrotic capacities of fibroblasts from these two regions contribute to this variability is unknown.

Objectives: We compared morphologic and functional characteristics of fibroblasts isolated from proximal airways and distal lung parenchyma to determine phenotypic differences.

Disclosing errors and adverse events in the intensive care unit.

Objective: To review the issue of disclosing errors in care and adverse events that have caused harm to patients in critical care.

Design: Review the scope of the problem, the definitions of errors and adverse events, and the benefits and problems of disclosing errors and adverse events and provide an approach by which to have these difficult discussions.

Setting: Medical center.

Prediction of shockwave failure in patients with urinary tract stones.

Purpose Of Review: To evaluate recent developments in predicting the failure of shockwave lithotripsy when treating patients with urinary tract stones.

Recent Findings: Although the features of patients with stones, as well as of the stones themselves, associated with refractoriness to shockwave lithotripsy are fairly well defined, refining the preoperative detection of these traits and optimizing the efficacy of shockwave lithotripsy are still under investigation. Several studies have recently focused on improving the radiological appraisal of stone size and composition through the use of axial computed tomography and reconstruction software.

Receptor editing for better or for worse.

Receptor editing has emerged from its original identification as a minor secondary mechanism of B cell tolerance to be considered as a dominant mechanism by which autoreactive immature B cells are rendered tolerant. Clonal deletion, previously regarded as the major mechanism of central B cell tolerance, has been shown by recent studies to operate secondarily and only when receptor editing is unable to provide a non-autoreactive specificity. Receptor editing has also been shown to operate during the development of wild-type B lymphocytes, and ongoing investigations demonstrate the influence of particular signaling molecules in the induction and/or inhibition of receptor editing.

Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost.

Objective: To evaluate a management protocol based on scientific evidence in the care of patients undergoing vaginal hysterectomy.

Study Design: (Canadian Task Force classification II-2).

Setting: 110-bed community hospital.

Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome.

Objectives: The purpose of this research was to define the predictors of the "slow-reflow" phenomenon during carotid artery intervention with filter-type embolic protection devices (EPDs) and to determine its prognostic significance.

Background: During carotid artery intervention using filter-type EPDs, we have observed cases in which there is angiographic evidence of a significant reduction in antegrade flow in the internal carotid artery proximal to the filter device, termed "slow-flow." The predictors of this phenomenon and its prognostic significance are unknown.

Receptor editing can lead to allelic inclusion and development of B cells that retain antibodies reacting with high avidity autoantigens.

Receptor editing is a major B cell tolerance mechanism that operates by secondary Ig gene rearrangements to change the specificity of autoreactive developing B cells. In the 3-83Igi mouse model, receptor editing operates in every autoreactive anti-H-2K(b) B cell, providing a novel receptor without additional cell loss. Despite the efficiency of receptor editing in generating nonautoreactive Ag receptors, we show in this study that this process does not inactivate the autoantibody-encoding gene(s) in every autoreactive B cell.

{gamma}{delta} T cell homeostasis is established in competition with {alpha}{beta} T cells and NK cells.

gammadelta T cells are a diverse population of lymphocytes that play an important role in immune regulation. The size of the gammadelta T cell pool is tightly regulated, comprising only 1-10% of total lymphoid T cells in mice and humans. We examined the homeostatic regulation of gammadelta T cells using a model of lymphopenia-induced homeostatic expansion.

Characterization of acute liver failure and development of a continuous risk of death staging system in children.

Background/aims: Acute liver failure (ALF) in children has been associated with an overall mortality of approximately 70% in the pretransplant era and 50-80% survival in those undergoing orthotopic liver transplantation. There is currently no system for staging severity of ALF in children. The aim of this study was to characterize pediatric ALF in a tertiary hospital and to derive a scoring system to stratify severity of ALF based on predicted mortality.

The channel kinases TRPM6 and TRPM7 are functionally nonredundant.

TRPM7 and its closest homologue, TRPM6, are the only known fusions of an ion channel pore with a kinase domain. Deletion of TRPM7 in DT40 B-lymphocytes causes growth arrest, Mg(2+) deficiency, and cell death within 24-48 h. Amazingly, in analogy to TRPM6-deficient patients who can live a normal life if provided with a Mg(2+)-rich diet, TRPM7-deficient DT40 B-lymphocytes show wild type cell growth if supplied with 5-10 mm Mg(2+) concentrations in their extracellular medium.

Insights from studies of blood substitutes in trauma.

Most authorities believe that the greatest need for blood substitutes is in patients with unanticipated acute blood loss, and trauma is the most likely scenario. The blood substitutes reaching advanced clinical trials today are red blood cell (RBC) substitutes, derived from hemoglobin. The hemoglobin-based oxygen carriers (HBOCs) tested currently in FDA Phase III clinical trials are polymerized hemoglobin solutions.

Targeting the distal lung in asthma: do inhaled corticosteroids treat all areas of inflammation?

Inflammation of the distal lung, which consists of the small airways (internal diameter <2 mm) and alveolar tissue, is an important feature of the asthma clinical syndrome comprising airway inflammation, airway hyperresponsiveness and bronchodilator-responsive expiratory airflow limitation. Support for this assertion is derived from histologic studies which have demonstrated evidence of inflammation in this anatomic compartment, along with additional studies, which have elucidated the radiologic and physiologic correlates of distal lung inflammation. Delivering inhaled drugs to this area is challenging and is dependent on a number of drug- and delivery device-related factors, as well as on a patient's inhaler technique and bronchial anatomy.

Quantitative computed tomography detects peripheral airway disease in asthmatic children.

The aim of this study was to compare air-trapping as quantified by high-resolution computed tomography (HRCT) of the chest with measures of lung function and airway inflammation in children with mild to moderate asthma. Plethysmography indices, respiratory resistance, and reactance before and after bronchodilator with impulse oscillation (IOS), exhaled nitric oxide (eNO), total eosinophil count (TEC), and serum eosinophil cationic protein (ECP) levels were measured in 21 subjects. A single-cut HRCT image at end-expiration was obtained.

TLR2 signaling is critical for Mycoplasma pneumoniae-induced airway mucin expression.

Excessive airway mucin production contributes to airway obstruction in lung diseases such as asthma and chronic obstructive pulmonary disease. Respiratory infections, such as atypical bacterium Mycoplasma pneumoniae (Mp), have been proposed to worsen asthma and chronic obstructive pulmonary disease in part through increasing mucin. However, the molecular mechanisms involved in infection-induced airway mucin overexpression remain to be determined.

Winter air pollution and disease parameters in advanced chronic obstructive pulmonary disease panels residing in Denver, Colorado.

Background: Ambient pollution might worsen chronic obstructive pulmonary disease (COPD).

Objective: We explored the associations of pollution to pulmonary function, rescue medication, and symptoms over 2 winters in 2 panels of subjects with advanced COPD in Denver, Colorado.

Methods: Subjects measured lung function and recorded symptoms and rescue medications.

Characterization of within-subject responses to fluticasone and montelukast in childhood asthma.

Background: Responses to inhaled corticosteroids (ICSs) and leukotriene receptor antagonists (LTRAs) vary among asthmatic patients.

Objective: We sought to determine whether responses to ICSs and LTRAs are concordant for individuals or whether asthmatic patients who do not respond to one medication respond to the other.

Methods: Children 6 to 17 years of age with mild-to-moderate persistent asthma were randomized to one of 2 crossover sequences, including 8 weeks of an ICS, fluticasone propionate (100 microg twice daily), and 8 weeks of an LTRA, montelukast (5-10 mg nightly depending on age), in a multicenter, double-masked, 18-week trial.