Finkbengtsen0583

7% (17/1040) of patients in periods I and II, respectively. Notably, the rate of late (>6 months since last procedure) CIED infection was significantly increased in period II (1.3% vs. 0.1%, p  less then  0.01), despite the rate of early infection (≤6 months) being comparable (0.4% vs. 0.6%, p = 0.58). On multiple logistic regression, revision [odds ratio (95% confidence interval) 5.2 (1.6-16.3), p = 0.005] and age [0.96, (0.93-0.99), p = 0.007] were identified as independent risk factors for CIED infection in period II. CONCLUSIONS Our findings suggest that the increasing incidence of CIED infection in current clinical settings was due to an increase in late CIED infection. Furthermore, revision and younger age were identified as independent risk factors for CIED infection in current clinical settings. Our data indicate that clinicians should consider whether the merit of a procedure can overcome the risk of infection when planning revision or implantation in younger patients. PURPOSE Doctors of Tomorrow (DoT) is a pipeline program between the University of Michigan Medical School and Cass Technical High School in Detroit where the overall mission is to encourage youth from communities that are underrepresented in medicine to pursue their interests in healthcare careers. Students have the opportunity to apply for a summer internship between 9th grade and 10th grade. There is limited literature on the effectiveness of experiential-learning opportunities in pipeline programs to support development of personal and professional skills. The purpose of this study was to examine the experiences of students participating in the DoT summer internship program in order to better understand how their engagement influenced personal and professional development. METHOD An exploratory qualitative study was conducted using responses from 27 students who participated in the DoT summer internship program between 2014 and 2018. Students engaged in self-reflective practices prompted by weekly surveys. Data were analyzed through an inductive process by coding and thematic analysis. RESULTS Four overarching themes were identified (1) engagement in authentic experiential-learning opportunities; (2) development of professional skills; (3) self-reflection and actualization; and (4) real world barriers in experiential-learning. CONCLUSIONS High school students engaged in a variety of different community internships and shared insights that illustrated depth and diversity of understanding health in their community. Their reflections illustrate the added value of experiential-education in pipeline programs. Collaborative research between the University School of Medicine Office of Diversity and Inclusion, Health Sciences Library and Department of African and African American Studies recently identified Dr. Charles Edgar Newsome as the institution's first African American physician graduate in 1893. Born May 25, 1856 in the town of Buffalo within Putnam County of Northwest Virginia, he served for 3 years and 6 months as a member of the Regimental Band of the United States Army 25th Infantry, also known as the Buffalo Soldiers, became Grand Master of the Grand United Order of Odd Fellows, and served communities of the state as a reverend, physician, and civic leader. Archival records and photographs uncover the remarkable life of Reverend Charles Edgar Newsome, MD, a hidden figure in history. OBJECTIVE Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) and worldwide interest in its implantation, TAVR valve explantation has not been well described. Ruboxistaurin METHODS We retrospectively reviewed 1442 consecutive patients who underwent a TAVR procedure between 2011 and 2019, in which TAVR explantation was performed in 15 patients (1.0%). In addition, 2 patients from outside institutions also underwent TAVR explantation at our institution. We reviewed the clinical details of these 17 patients. RESULTS The frequency of TAVR explant increased over time from 0 to 1 during the period from 2011 to 2015 to 6 in 2019. The mean age was 73.0 ± 9.3 years. The majority of patients (88.2%) were in New York Heart Association functional class IV heart failure. The Society of Thoracic Surgeons Predicted Risk of Mortality score was significantly higher at the time of explantation than at the time of the original TAVR (3.5% vs 9.9%; P  less then  .001). The indication for explantation included structural valve degeneration (23.5%), severe paravalvular leak (41.2%), TAVR procedure-related complications (23.5%), endocarditis (5.9%), and bridge-to-definitive surgery (5.9%). Neoendothelialization of the TAVR valve into the aortic wall requiring intense aortic endarterectomy was noted in all 5 of the TAVR valves older than 1 year, in which 2 (40%) required unplanned aortic root repair. There were 2 (11.8%) in-hospital mortalities. CONCLUSIONS Surgical TAVR valve explant is increasing and may become common in the near future. The clinical effects of explanting chronically implanted valves with the potential need for aortic repair is not negligible. These data should be used to more appropriately select TAVR candidates as TAVR practices expand into younger and lower risk patients. OBJECTIVE Dysregulation of local nitric oxide (NO) synthetases occurs during ischemia and reperfusion associated with cardiopulmonary bypass, deep hypothermic circulatory arrest (DHCA), and reperfusion. Rapid fluctuations in local NO occurring in neonates and infants probably contribute to inflammation-induced microglial activation and neuronal degeneration after these procedures, eventually impairing neurodevelopment. We evaluated the anti-inflammatory efficacy of inhaled NO (iNO) in a piglet model emulating conditions during pediatric open-heart surgery with DHCA. METHODS Infant Yorkshire piglets underwent DHCA (18°C) for 30 minutes, followed by reperfusion and rewarming either with or without iNO (20 ppm) in the ventilator at the onset of reperfusion for 3 hours (n = 5 per group, DHCA-iNO and DHCA). Through craniotomy, brains were extracted after perfusion fixation for histology. RESULTS Plasma NO metabolites were elevated 2.5 times baseline data before DHCA by iNO. Fluoro-Jade C staining identified significantly lower number of degenerating neurons in the hippocampus of the DHCA-iNO group (P = .