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Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention. Front Public Health 2024; 11:1268888. [PMID: 38328544 PMCID: PMC10847218 DOI: 10.3389/fpubh.2023.1268888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.
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Abstract No. 165 Prospective, Multi-Center, Registry Study of Radial Access Embolization Procedures: 12 Month Outcomes (RAVI Registry - NCT04272216). J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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3
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MA11.09 Artificial Intelligence in Lung Cancer Screening: Accuracy and Predictive Value. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Automated HIV screening in the emergency department –earlier diagnosis, improved clinical outcomes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
HIV/AIDS is a public health problem worldwide because undiagnosed patients maintain onward transmission. To stop viral transmission an upscale in diagnostics is needed so that more patients start treatment; patients on treatment and with undetectable viral load do not transmit the virus to other persons (“Treatment as Prevention”).
Objectives
We aimed at identifying more HIV infections in the emergency Department (ED) and at doing so earlier in the course of disease.
Methods
we designed an automated and clinician independent HIV screening project in the ED. Electronic Medical Record (EMR) automatically generates a request for HIV antibody (HIV Ab) test when a patient: a) is 18-65 years of age and has a request for any blood test; b) is not identified in the EMR as being HIV infected; c) does not have an HIV Ab in the EMR in the previous year. Nursing staff receive a visual warning of patients' eligibility for screening and an extra tube label is printed out for HIV testing. The patient is informed of screening at the moment of blood drawing and an <<opt-out >> strategy is applied (optional verbal informed consent or <<opt-out >> of screening).
Results
In 16 months, a total of 21.487 people were eligible for screening. 18.072 HIV Ab screening tests were done. The opt-out rate was 6.3% and there were 44 new HIV diagnostics (prevalence rate 0.24%). Late presenting patients (baseline CD4 counts <350) dropped from an average of 56% in the previous 6 years at our institution to 36.3%. Median CD4 count at diagnostics went up from 192 to 388 cells/mm³.
Conclusions
An automated and clinician independent HIV screening program in the ED proved to be successful at identifying more HIV patients and at tackling the problem of late presentation. Diagnosing early in the course of infection is beneficial for the individual patient, but also represents a gain in general public health because onward transmission is stopped by starting antiretroviral treatment.
Key messages
Early diagnosis through universal screening. Treatment as prevention.
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Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores. Diabet Med 2018; 35:360-367. [PMID: 29055156 PMCID: PMC5836992 DOI: 10.1111/dme.13532] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/22/2022]
Abstract
AIMS The comparative efficacy of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c , age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2-year post-surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission. METHODS A retrospective single-centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression. RESULTS The proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817-0.916); DiaRem: 0.865 (95%CI: 0.814-0.915), P=0.856]. Two-year % weight loss was higher post RYGB [26.6 (95%CI: 24.8-28.4)] vs post-sleeve gastrectomy [20.6 (95%CI: 18.3-22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12-5.60), P=0.025]. This association became non-significant when adjusted for % weight loss. CONCLUSION DiaBetter and DiaRem scores predict diabetes remission following both procedures. Two-year % weight loss plays a key role in determining diabetes remission.
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Randomized, prospective comparison of radial versus femoral approach on transarterial liver embolization: BEST liver access trial. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Safety and efficacy of conventional transarterial embolization (cTACE) followed by percutaneous thermal ablation (PTA) of unresectable hepatocellular carcinoma (HCC): single-center 9-year experience. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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8
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Efficacy and safety of combined liver embolization and ablation in a single treatment session compared with combined liver embolization and ablation performed in separate treatment sessions. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Walk in clinic: In-hospital or off campus? J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Safety and efficacy in use of superselective radiofrequency embolization wire on small animal arteries. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Time-driven activity-based cost accounting methodology to improve cost-effectiveness in vascular and interventional radiology service at a large university academic medical center. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Radial access for liver-directed therapy: a single center prospective study. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Radial access for interventional radiology procedures. Just an alternative access or an excellent model aligned with the upcoming changes of the healthcare reform? J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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New technologies for CAS that might overcome the burden of microembolization. THE JOURNAL OF CARDIOVASCULAR SURGERY 2015; 56:859-865. [PMID: 26173393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microembolization during carotid artery stenting (CAS) is the result of embolic events shown by intraprocedural transcranial Doppler (TCD) or postprocedure diffusion-weighted MRI that do not lead to acute neurological deficit. Although the long term clinical outcome of these silent infarcts is not yet well established, there is increasing evidence that these events could be associated with neurological impairments, such as cognitive decline. In order to prevent microembolization due to excessive catheter manipulation at the time of guiding catheter placement in patients with challenging anatomy, a cervical access system with flow reversal protection was developed. Other embolic events are often seen as the result of plaque protrusion through stent struts. A new type of stent, so-called "hybrid" stent, incorporates the flexibility and conformability of an open-cell stent as well as plaque coverage seen with a close-cell stent, with the goal of achieving better plaque stabilization reducing macro and microembolization, while maintaining original vessel anatomy and flow hemodynamic. At the present time there are three different stents under investigation or this application.
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Implementation of a hospital antibiotic stewardship program: first results. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475119 DOI: 10.1186/2047-2994-4-s1-p180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Advantages to Indigo mechanical thrombectomy for ALI: device and technique. THE JOURNAL OF CARDIOVASCULAR SURGERY 2015; 56:393-400. [PMID: 25644826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Catheter-directed thrombolysis (CDT) has been used as the first therapeutic option for acute limb ischemia (ALI) due to its less invasive nature; however, recent systematic review showed higher incidence of major complications related to lytic infusion, including hemorrhagic stroke. In this setting, aspiration thrombectomy with Indigo has the greatest advantage of not increasing systemic risk of bleeding. The Indigo™ system from Penumbra® (Alameda, CA, USA) promotes active thrombectomy using a vacuum pump that generates substantial suction, enabling aspiration of clots of varying sizes and lengths. The device has three components: aspiration catheter, separator and pump. There are 2 aspiration catheter sizes: CAT 3 and CAT 5. The separators are intended to mobilize the clot and clean the catheter lumen, and therefore restoring flow for continuous aspiration. The pump is small-sized equipment capable of applying near pure vacuum aspiration pressure of -29 mmHg. Aspiration thrombectomy with Indigo has two key advantages: it does not require the use of lytics, and it provides immediate flow reestablishment. Its use when thrombolysis is contraindicated or has failed is already well established and, in the future, it may likely become the first line endovascular option in patients with acute limb ischemia.
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Incomplete yttirum-90 infusion and high residual radioactivity during radioembolization. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Reducing delays and eliminating waste in vascular interventional radiology. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Quantitative linear and nonlinear resonance inspection techniques and analysis for material characterization: application to concrete thermal damage. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2014; 136:537-546. [PMID: 25096088 DOI: 10.1121/1.4887451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Developed in the late 1980s, Nonlinear Resonant Ultrasound Spectroscopy (NRUS) has been widely employed in the field of material characterization. Most of the studies assume the measured amplitude to be proportional to the strain amplitude which drives nonlinear phenomena. In 1D resonant bar experiments, the configuration for which NRUS was initially developed, this assumption holds. However, it is not true for samples of general shape which exhibit several resonance mode shapes. This paper proposes a methodology based on linear resonant ultrasound spectroscopy, numerical simulations and nonlinear resonant ultrasound spectroscopy to provide quantitative values of nonlinear elastic moduli taking into account the 3D nature of the samples. In the context of license renewal in the field of nuclear energy, this study aims at providing some quantitative information related to the degree of micro-cracking of concrete and cement based materials in the presence of thermal damage. The resonance based method is validated as regard with concrete microstructure evolution during thermal exposure.
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Radiofrequency wire for the recanalization of chronic arterial occlusions that have failed conventional endovascular techniques. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Carotid stenting in asymptomatic patients: how to identify patients without symptoms and at high risk for neurologic events. THE JOURNAL OF CARDIOVASCULAR SURGERY 2013; 54:55-59. [PMID: 23296416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During the last 20 years, asymptomatic patients with high-grade carotid stenosis have been treated with carotid endarterectomy and more recently with carotid artery stenting in order to prevent stroke. New, best medical treatment including statins, beta-blockers, antiplatelet therapies, and better diabetes and blood pressure control might reduce the incidence of stroke in this patient population making invasive treatment unnecessary. However, patients with asymptomatic carotid stenosis cannot be considered a homogenous population, and therefore, the therapeutic approach should take into consideration a subgroup of patients with greater risk of cerebrovascular event. Unfortunately, these risk factors are not well categorized thus far, although multiple publications have addressed each one of these factors individually. Recognizing these risk factors is essential for optimizing surveillance and therapeutic approach based on individual risk. The purpose of this article is to review such factors, including patient history, presence of embolic signals on Transcranial Doppler ultrasound, and plaque morphology. These factors should identify high risk asymptomatic individuals who could benefit from carotid stenting or carotid endarterectomy.
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Hepatic endometriosis diagnosed by liquid-based cytology: A Case Report. Diagn Cytopathol 2013; 42:441-4. [DOI: 10.1002/dc.22945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 12/04/2012] [Indexed: 11/06/2022]
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Abstract No. 159: Importance of the angiographic identification of the right gastric artery anatomic origin in the era of Yttrium-90 liver radioembolization. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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P1-25 Potential bias in HIV estimates using RDS sampling. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract No. 372: Animal models in interventional radiology. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract No. 159: Predictive factors for the development of type 2 endoleaks. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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POD-1.04: The bone-anchored perineal male sling for post-prostatectomy incontinence: results up to 5 years of follow-up. Urology 2010. [DOI: 10.1016/j.urology.2010.07.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract No. 183: Successful recanalization of chronic benign central venous occlusion with radiofrequency puncture wire technique. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract No. 289 EE: Successful Recanalization of Bile Duct Occlusion with Radiofrequency Puncture Wire Technique. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Use of percutaneous closure devices in the removal of central venous catheters from inadvertent arterial catheterizations. THE JOURNAL OF CARDIOVASCULAR SURGERY 2008; 49:345-350. [PMID: 18446120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Although rare, misplacement of central venous catheters in supra-aortic arteries is potentially fatal. Five patients had safe catheters removal using percutaneous closure devices. Three patients were coagulopathic, 3 under intensive care and 1 in immediate postoperative limb amputation. Patients were treated successfully, with immediate hemostasis and without complications in a mean follow-up of 12.5 months. Although the number of patients is small, the closure devices proved to be safe. This is a minimally invasive alternative technique in the management of large bore catheters removed from non-compressible puncture sites such as subclavian and brachiocephalic arteries.
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205 TREATMENT OF MALE STRESS URINARY INCONTINENCE WITH THE BONE-ANCHORED PERINEAL SLING. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1569-9056(07)60204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Techniques for carotid artery stenting under cerebral protection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2005; 46:201-17. [PMID: 15956918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Carotid angioplasty and stenting is an alternative to carotid endarterectomy in the treatment of carotid artery stenosis. During the stenting process, however, distal embolization usually occurs, and the particles released may cause neurologic problems or death. Thus, the safety of carotid stenting depends partly on use of a cerebral protection device during the procedure. Three principal types of protection mechanisms have been developed: distal balloon occlusion, distal filtration, and proximal occlusion with or without reversal of flow. Products using these mechanisms have been manufactured by a variety of companies, and many are used routinely outside the United States (US). One distal filter, the RX Accunet, has been approved by the US Food and Drug Administration for clinical use. Large clinical trials of most of the newest carotid stents and cerebral protection devices are under way, and some initial results have been reported. Several clinical series in which cerebral protection was employed have also been described. Each type of protection device has advantages and disadvantages, which are discussed in this review.
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Abstract
The expression of the Fos and Jun families of nuclear phosphoproteins can be induced by a variety of extracellular stimuli and is known to participate in the transcriptional regulation of target genes. To examine the role of these transcription factors in retinal function, we used polyclonal antisera to localize these protein families in the turtle retina. Fos-like immunoreactivity was in many somata in the inner nuclear and ganglion cell layers. In contrast, Jun-like immunoreactivity was in a smaller number of amacrine cells and many somata in the ganglion cell layer. The monostratified dendritic arbors of one prominent amacrine cell type with Jun-like immunoreactivity were also labeled. There were no dramatic differences in the levels of Fos-like immunoreactivity or Jun-like immunoreactivity between light- or dark-adapted retinas. We examined the effects of excitatory amino acids and gamma-aminobutyric acid (GABA) on the expression of these proteins in vitro. In some experiments, cobalt was used to block synaptic transmission. The excitatory amino acids increased both Fos- and Jun-like immunoreactivity, while GABA generally showed no such stimulatory effect. In cobalt-treated retinas, the same cell types had Jun-like immunoreactivity as seen in the controls, but overall levels of immunoreactivity were increased. In cobalt-treated dark-adapted retinas, some excitatory amino acids increased cytoplasmic Fos-like immunoreactivity in the somata and processes of large cells in the ganglion cell layer. Our results suggest that Fos- and Jun-related proteins may play an important role in the postsynaptic responses to amino acid transmitters in a wide variety of amacrine and ganglion cells.
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A randomized trial of empirical antibiotic therapy with one of four beta-lactam antibiotics in combination with netilmicin in febrile neutropenic patients. J Antimicrob Chemother 1988; 22:237-47. [PMID: 3053555 DOI: 10.1093/jac/22.2.237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Over a two year period 174 evaluable episodes of fever in neutropenic patients were treated in a randomized study comparing four beta-lactam antibiotics, each given in combination with netilmicin. Exclusions included episodes due to viral or fungal infection, and trial violations. Most patients were receiving treatment for leukaemia, including 18% undergoing bone marrow transplantation. The overall response rate (EORTC criteria) was 66%, ranging from 56% for cefoperazone to 76% for mezlocillin. Microbial documentation was obtained in 31% of episodes; Gram-positive isolates were most frequent but Pseudomonas aeruginosa was found in 18 patients. In patients with microbiologically documented infection 70% improved, overall--from 40% with cefoperazone to 80% with piperacillin (P less than 0.05). Nephrotoxicity was seen in 6.7% and was associated with severe documented sepsis. Hypokalaemia was seen in 29% and was most marked in patients receiving ticarcillin. Rashes occurred in 6.6% overall, with no difference between the groups. Ototoxicity, shown by serial audiograms, was seen in 4.7% of patients. No evidence of vestibular dysfunction was seen in 62 patients studied. Of thirteen deaths due to the primary infection, seven were caused by Ps. aeruginosa and five by fungi.
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Tumor size, response rate, and prognosis in small cell carcinoma of the bronchus treated by combination chemotherapy. CANCER TREATMENT REPORTS 1982; 66:463-470. [PMID: 6277486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Ninety-eight patients with small cell carcinoma of the bronchus (SCCB) were treated with a combination of cyclophosphamide, methotrexate with calcium leucovorin rescue, and lomustine (CCNU). VP-16-213 was given on relapse. Response rate and survival were analyzed according to extent of tumor, presence of the syndrome of inappropriate antidiuretic hormone production (SIADH), and, in 38 patients, size of intrathoracic tumor as measured by computerized tomographic (CT) scanning. The median survival of the entire group was 34.6 weeks. In patients with limited disease the median survival was 46 weeks compared to 29 weeks for those with extensive disease. This difference in survival between patients with limited and extensive disease was most marked in those showing a partial response (median survival, 45.9 and 28 weeks, respectively). Patients with ectopic antidiuretic hormone production had a poor prognosis even if they had achieved a complete response. Only one partial response to VP-16-213 occurred. There was a strong correlation between initial intrathoracic tumor size as assessed by total cross-sectional area on CT scan and response and survival. When the total area exceeded 30 cm2 there were no complete responders, but there were complete responses in eight of 21 patients when the area was less than 30 cm2. The relationship between intrathoracic tumor size and response rate was present when analyzed according to disease extent, age, sex, and performance status. A clear relationship between total tumor area and survival was also found. When SCCB is treated with chemotherapy alone, the prognosis is better for those patients who present with limited disease, without SIADH, and with small intrathoracic tumor. In this group it is possible that further intensification of therapy may result in prolonged survival.
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