Mcgarryboyer3691

g in reduced circulation of the coronavirus, lower daily PM concentration in outdoor air, as well as to meteorological stability and higher temperature that characterize spring season. Further research should be carried out during winter, in presence of higher viral circulation and daily PM exceedances.

Ascending aortic aneurysms (AsAA) remain a silent killer for which timely intervention and surveillance intervals are critical. Despite this, little is known about the follow-up care patients receive after incidental detection of an AsAA. We examined the pattern of surveillance and follow-up care for these high-risk patients.

We identified patients at our institution with incidentally detected AsAAs (>37 mm) between 2013 and 2016. We collected information on patients' aneurysms and clinical follow-up. Logistic regression models related aneurysm size and demographics to whether patients received follow-up imaging or referral.

From 2013-2016, 261 patients were identified to have incidentally detected AsAAs among the 21,336 CT scans performed at our institution. The median aneurysm size was 4.2 cm (interquartile range 4.0, 4.4). Only 18 (6.9%) of the identified patients were referred to a cardiac surgeon for evaluation and only 37.9% of the identified patients had a follow-up chest CT scan within 1 year of detection. 34% had an echocardiogram. The median follow-up duration for the study was 5 years. Logistic regression models showed that aneurysm size and family history were significant predictors of whether a patient was referred to a cardiac surgeon (odds ratio 10.34, 95% confidence interval = 2.3 - 47.9), but not whether the patients received follow-up imaging.

Among 261 patients with incidentally detected AsAAs, only a third received any follow-up imaging within one year after detection, with very low clinical penetrance for expert referral. selleck inhibitor Surveillance of this high-risk patient population appears insufficient and may require standardization.

Among 261 patients with incidentally detected AsAAs, only a third received any follow-up imaging within one year after detection, with very low clinical penetrance for expert referral. Surveillance of this high-risk patient population appears insufficient and may require standardization.

Anticoagulation management during veno-arterial extracorporeal membrane oxygenation (ECMO) is particularly difficult in postcardiotomy shock patients given a significant bleeding risk. We sought to determine the effect of anticoagulation on bleeding and thrombosis risk for postcardiotomy shock patients on ECMO.

We retrospectively reviewed patients who received ECMO for postcardiotomy shock from July 2007 through July 2019. Characteristics of patients who developed bleeding and thrombosis were investigated and risk factors were assessed via multi-level logistic regression.

Of the 152 patients who received ECMO for postcardiotomy shock, 33 (23%) developed 40 thrombotic events and 64 (45%) developed 86 bleeding events. Predictors of bleeding were intraoperative packed red blood cell transfusion (OR 1.05, 95% CI [1.01-1.09]), platelet transfusion (OR 1.10, 95% CI [1.05-1.16]), international normalized ratio (OR 1.18, 95% CI [1.02-1.37]), and activated partial thromboplastin time (aPTT) greater than 60 seconds (OR 2.32, 95% CI [1.14-4.73]). Predictors of thrombosis were anticoagulation use (OR 0.39, 95% CI [0.19-0.79]), surgical venting (OR 3.07, 95% CI [1.29-7.31]), hemoglobin (OR 1.38, 95% CI [1.06-1.79]), and central cannulation (OR 2.06, 95% CI [1.03-4.11]). The daily predicted probability of thrombosis was between 0.075 and 0.038 in those who did not receive anticoagulation and decreased to between 0.030 and 0.013 in those who received anticoagulation at aPTTs between 25 and 80 seconds.

Anticoagulation can reduce thromboembolic events in postcardiotomy shock patients on ECMO, but bleeding risk may outweigh this benefit at aPTTs greater than 60 seconds.

Anticoagulation can reduce thromboembolic events in postcardiotomy shock patients on ECMO, but bleeding risk may outweigh this benefit at aPTTs greater than 60 seconds.

Lung volume reduction surgery (LVRS) is treatment for chronic obstructive pulmonary disease (COPD), the second most common indication for lung transplantation (LTx) in the US. LVRS prior to LTx is controversial. Single institution studies report contradicting results, and the impact of undergoing LVRS prior to LTx on outcomes after LTx is unclear.

We reviewed the United Network for Organ Sharing database for all adults (age>18) who underwent first-time LTx for COPD in the Lung Allocation Score era. We used patient demographic and clinical characteristics, and LAS to propensity match patients who did and did not undergo LVRS prior to LTx. The primary exposure was prior LVRS. The primary outcome was graft failure after LTx. Unadjusted Kaplan Meier and Adjusted Cox proportional hazards modeling were used to assess outcomes.

A total of 4,905 patients with COPD underwent LTx between May 2005 and March 2017. Of them, 107 patients (2.2%) underwent LVRS prior to LTx. Propensity matching generated 212 matches (106 LVRS+LTx, and 106 LTx-only). Median survival was significantly longer in the LTx-only cohort (6.5 years versus 3.4 years, p=0.034). LVRS prior to lung transplantation was associated with significantly increased risk of graft failure after lung transplant (HR1.72, 95% CI 1.13-2.60, p=0.01).

In this national, propensity matched analysis of LVRS prior to LTx, we show that LVRS is associated with a significantly increased risk of graft failure. Patients who undergo LVRS and remain in need of LTx should be carefully assessed and followed post-operatively.

In this national, propensity matched analysis of LVRS prior to LTx, we show that LVRS is associated with a significantly increased risk of graft failure. Patients who undergo LVRS and remain in need of LTx should be carefully assessed and followed post-operatively.

The Fontan procedure, the last of a series of palliative operations for patients born with single ventricles, is associated with a significant late burden of complications. There are other strategies for patients who are suboptimal candidates for Fontan completion, however the long-term outcomes of these different surgical options have not been clearly elucidated. We performed a systematic literature review to establish the current role of other treatment approaches besides the Fontan procedure.

MEDLINE and Embase databases were systematically searched for articles describing the long-term outcomes of patients with single ventricles who have not received the Fontan procedure.

A total of 36 articles met all inclusion criteria. There is a scarcity of contemporary data on the non-Fontan cohort. Historical studies provided a significant contribution.

Long-term survival in unoperated patients with single ventricles is possible under the rare conditions of having balanced hemodynamics. Up to half of patients may survive on only a systemic-to-pulmonary artery shunt or bidirectional cavopulmonary shunt for over 20 years with reasonable functional status.