Invasive Devices Research Articles

CARD25: Development of a Minimally Invasive Single Port Pulsatile Ventricular Assist Device

Purpose: Our goal is to develop a compact, single port, pulsatile ventricular assist device (VAD) for total left ventricle (LV) support that only requires a minimally invasive single cannulation from apex to aorta. Methods: Standard diaphragm displacement pumps have 2 valved ports and inlet/outlet cannulas to alternate between blood infusion and withdrawal. By contrast, our compact single port pulsatile VAD consists of a valved single lumen cannula and a valveless single port diaphragm displacement pump. Via a small left thoracotomy, the valved single lumen cannula is inserted from apex to aorta (Fig). Four one-way inlet valves on the valved single lumen cannula wall allow blood withdrawal from LV, and a tri-leaflet outlet valve at the cannula tip allows blood delivery to aorta. The 28 Fr valved single lumen cannula prototype was made as one piece by polyurethane (PU) dip molding with memory alloy reinforcement. The two halves of the valveless single port diaphragm displacement pump prototype housing were made by polycarbonate vacuum thermoforming and assembled with a flexible PU membrane diaphragm in the middle to separate the blood and pneumatic chambers. This pump had a 60 cc stroke volume. A closed mock loop with 37% glycerin was used to mimic the LV-aortic valve-ascending aorta tract. Priming volume and reservoir height were adjusted to maintain 70 mm Hg diastolic aortic pressure and 16 mm Hg preload. Circuit flow and pressure in valved single lumen cannula were recorded. The catheter introducer with pressure transducer on tip was inserted through apex in adult sheep (n=5, 44-52 kg), with pressure wave form guiding tip into ascending aorta. The valved single lumen cannula slid along introducer through apex, crossing aortic valve, with its tip in ascending aorta. The valved single lumen cannula was connected to the single port diaphragm displacement pump. Pumping was increased for a normal cardiac output. The single port pulsatile VAD prototype performance was assessed for 6 hrs with hemodynamics/blood counts recorded. Results: The valved single lumen cannula and single port diaphragm displacement pump prototypes were fabricated as designed. The bench study showed that the single port pulsatile VAD achieved a pumping flow of up to 3.75 L/min. Valve regurgitation was <3%. In the sheep study, the valved single lumen cannula was easily installed within 1 min at first attempt. The single port pulsatile VAD achieved maximal 3.75 L/min pumping flow in a 52 kg sheep. The single port pulsatile VAD had consistent pumping flow through 6 hrs with stable hemodynamics (Table). Hemoglobin and platelet/white blood cell counts were unchanged. No obvious injury or thrombosis in heart or single port pulsatile VAD were observed at necropsy. Conclusions: Our single port pulsatile VAD only requires a single apex cannulation with valved single lumen cannula to achieve reliable LVAD performance, showing great promise for a short to mid-term minimally invasive LVAD.Figure 1. Our single port pulsatile ventricular assist device with a valved single lumen cannula and a valveless single port diaphragm displacement pump. Table 1. - Hemodynamics and Blood Count Results Sheep 1-5 Baseline Pump Run1 hr Pump Run3 hr Pump Run6 hr sABP (mm Hg) 111±15.5 138±19.5 122±16.4 113±16.2 CVP (mm Hg) 11±0.4 11±0.8 11±0.5 11±0.8 CO (L/min) 2.5±0.38 3.8±0.98 3.6±0.66 3.5±0.66 Pump Flow (L/min) 0±0 2.8±0.65* 2.7±0.65* 2.7±0.52* HR (bpm) 154±61.1 104±44.7 105±39.3 127±16 WBC (103/uL) 4.1±0.14 N/A N/A 4.8±2.57 PLT (103/uL) 467±93.3 N/A N/A 380±171 HgB (g/dL) 9.4±0.45 N/A N/A 9.1±0.38 * p<0.05 vs Baseline sABP=systolic arterial pressure, CVP=central venous pressure, CO=cardiac output, HR=heart rate, WBC=white blood cell count, PLT=platelet count, HgB=hemoglobin, and N/A=not applicable.

ID: 212903 An Injectable Wire Mesh Electrode (BASMATI Injectrode) Enables Minimally Invasive Stimulation Therapy in Clinical Trial

Individuals suffering from chronic pain undergo surgical procedures to receive neuromodulation devices, often requiring revision surgery to replace an exhausted battery with a new device. There is a need to eliminate revision surgery with a minimally invasive device. The Injectrode is an injectable electrode designed for rapid placement and removal by a minimally invasive procedure. Here we present data from a non-significant risk clinical trial to assess the safety and function of the Injectrode via a subcutaneously placed gold mesh (BASMATI Injectrode) for 28 days.

Efforts toward the continuous monitoring of molecular markers of performance.

Technologies supporting the continuous, real-time measurement of blood oxygen saturation and plasma glucose levels have improved our ability to monitor performance status. Our ability to monitor other molecular markers of performance, however, including the hormones known to indicate overtraining and general health, has lagged. That is, although a number of other molecular markers of performance status have been identified, we have struggled to develop viable technologies supporting their real-time monitoring in the body. Here we review biosensor approaches that may support such measurements, as well as the molecules potentially of greatest interest to monitor. Narrative literature review. Literature review. Significant effort has been made to harness the specificity, affinity, and generalizability of biomolecular recognition in a platform technology supporting continuous in vivo molecular measurements. Most biosensor approaches, however, are either not generalizable to most targets, or fail when challenged in the complex environments found in vivo. Electrochemical aptamer-based sensors, in contrast, are the first technology to simultaneously achieve both of these critical attributes. In an effort to illustrate the potential of this platform technology, we both critically review the literature describing it and briefly survey some of the molecular performance markers we believe will prove advantageous to monitor using it. Electrochemical aptamer-based sensors may be the first truly generalizable technology for monitoring specific molecules in situ in the body and how adaptation of the platform to subcutaneous microneedles will enable the real-time monitoring of performance markers via a wearable, minimally invasive device.

Multidrug-resistant gram-negative bacteria in patients with COVID-19: An epidemiological and clinical study

Epidemiological data regarding the incidence of secondary multidrug-resistant (MDR) Gram-negative infection in patients with coronavirus disease (COVID-19) in Brazil are still ambiguous. Thus, a case-control study was designed to determine factors associated with the acquisition of MDR Gram-negative bacteria (GNB) in patients with and without COVID-19 and describe the mortality rates and clinical features associated with unfavorable outcomes. In total, we assessed 280 patients admitted to Brazilian intensive care units from March/2020 to December/2021. During the study, 926 GNB were isolated. Out of those, 504 were MDR-GNB, representing 54.4% of the resistance rate. In addition, out of 871 patients positive for COVID-19, 73 had secondary MDR-GNB infection, which represented 8.38% of documented community-acquired GNB-MDR infections. The factors associated with patients COVID-19-MDR-GNB infections were obesity, heart failure, use of mechanical ventilation, urinary catheter, and previous use of β-lactams. Several factors associated with mortality were identified among patients with COVID-19 infected with MDR-GNB, including the use of a urinary catheter; renal failure; and the origin of bacterial cultures such as tracheal secretion, exposure to carbapenem antibiotics, and polymyxin. Mortality was significantly higher in patients with COVID-19-MDR-GNB (68.6%) compared to control groups, where COVID-19 was 35.7%, MDR-GNB was 50%, and GNB was 21.4%. Our findings demonstrate that MDR-GNB infection associated with COVID-19 has an expressive impact on increasing the case fatality rate, reinforcing the importance of minimizing the use of invasive devices and prior exposure to antimicrobials to control the bacterial spread in healthcare environments to improve the prognosis among critical patients.

Antithrombotic management in patients undergoing cardiac implantable electronic device implantation

Cardiac implantable electronic devices (CIEDs) are an established treatment option for arrhythmias, sudden cardiac death prevention, and heart failure. Approximately 1000 devices are implanted per million inhabitants in European countries each year. However, the main concern in patients with an indication for CIED implantation is frequently associated with comorbidities requiring antithrombotic medications. The invasive device implantation procedure represents a bleeding risk ranging from pocket hematoma to cardiac tamponade. On the other hand, temporary interruption of antithrombotic therapy increases the risk for thromboembolic events. Implanting CIEDs in patients on antithrombotic medications incites several clinical dilemmas of balancing thromboembolic risk against bleeding risk, as complications are associated with higher mortality rates in both aspects. The most common bleeding complication is pocket haematoma formation, which is associated with a prolonged hospital stay, higher cost, higher risk of pocket infection, and thus higher morbidity and mortality. Studies have shown that the heparin bridging strategy in patients on oral anticoagulants imposes a greater risk for pocket haematoma formation and no benefit in reducing thromboembolic events. Most procedures of CIED implantation can be performed safely with uninterrupted oral anticoagulants. Dual antiplatelet therapy increases the risk of pocket haematoma and should be avoided whenever possible.

559 Verticalization Therapy for ICU-Level Burn Patient: A Case Study

Abstract Introduction The entire interdisciplinary team can be faced with many challenges when treating a bariatric, critically ill patient with significant burn injuries. Some studies suggest that the care of these patients increases staff workload and leads to the need for increased assistance for proper turning, positioning, and completion of wound care. When caring for these types of patients, patient and staff safety should be considered, as well as what will ensure the best patient outcomes. Our rehab team initiated the use of verticalization therapy with a patient on the burn unit with 28% TBSA full-thickness burns to back, chest, BUEs and a BMI of 45.8 in order to promote improved healing, cognitive status, and pulmonary function. While verticalization therapy is described for use in patients with pulmonary issues or invasive cardiac support devices, this was the first time this therapy was used in our busy ABA-verified burn center. Methods Once deemed appropriate for participation with PT/OT, a collaborative protocol with nursing, therapy, and burn provider team was developed. The patient was transitioned into a specialized bed allowing for verticalization up to 90 degrees. The patient was incrementally verticalized by 10 degrees at a time while monitoring vitals, assessing patient safety and pain response. Ultimately, the patient reached 40 degrees vertical and maintained this position for up to 2 hours. This intervention was utilized by both rehab specialists and nursing staff and was taught to nursing staff to be performed daily until patient was able to actively participate and tolerate edge of bed or out of bed activity. Results Use of the verticalization positioning was used to promote weight bearing activity, improve pulmonary function, improve cognitive status through upright positioning, and for pressure relief of graft areas specifically for offloading pressure to back wounds and grafts. The bed was used for 1 month. During this time, the patient successfully liberated from mechanical ventilation and shock state and mobilized with therapy assistance. The patient demonstrated improved strength, active participation with therapies, and decreased agitation as the month progressed. Autograft split-thickness skin grafts with autologous cell suspension epithelial autografts to the patient’s posterior torso healed well and were fully closed by the time of discharge to inpatient rehabilitation. Conclusions Use of verticalization beds can be implemented in the care of patients with burn injuries safely and successfully. Further research regarding skin healing related to use of the bed and verticalization therapy in burn injured patients should be conducted. Applicability of Research to Practice This intervention can be used for patients of all sizes and can be implemented as soon as hospital day one, if the patient is medically appropriate

Intraoperative Optical Coherence Tomography for Ab Interno Trabecular Bypass Glaucoma Surgery.

The purpose of this study was to demonstrate a case of a novel surgical technique utilizing intraoperative optical coherence tomography (iOCT) to aid implantation and optimal placement of 2 trabecular bypass minimally invasive glaucoma surgery devices-the iStent inject W and the Hydrus microstent. In iStent inject W implantation, where the depth of stent implantation has been correlated to postoperative outcomes. the iOCT allowed real-time appreciation of device implantation depth relative to the trabecular meshwork surface. In Hydrus microstent implantation, the iOCT allowed confirmation of successful stent placement within the Schlemm canal, and may help in cases where intraoperative gonioscopic view of the 3 microstent windows is impeded. This case demonstrated the use of the iOCT as an imaging adjunct to ensure optimal placement of trabecular bypass minimally invasive glaucoma surgery devices such as the iStent inject W and Hydrus microstent.

4D printing of multi-stimuli responsive rigid smart composite materials with self-healing ability

Smart materials combined with favourable mechanical strength, high self-healing efficiency, and multi-stimuli responsive ability show promising applications in diverse fields, such as biotechnology and minimally invasive devices. However, the mutually exclusive conflicts among these properties make it challenging to balance them simultaneously. In this study, we proposed a multi-stimuli responsive rigid smart material based on modularization scheme for the first time, which can respond to temperature and magnetic stimulation, are designed and successfully prepared by 4D printing of shape memory epoxy resin, Fe3O4@GO, and self-healing microcapsules. The resultant smart materials show excellent tensile strength (17.2 MPa), high self-healing efficiency (91.2%) at room temperature, and rapid magnetic-stimuli responsive (15 s). It is worth noting that the recovery rate of fractured samples can be still up to 82.0% after three times fracture repairs, suggesting their strong self-healing ability at room temperature. More importantly, the obtained materials can be further exploited for a wide variety of applications, such as smart space deformable structures, temperature sensors, and grippers, exhibiting enormous potential for the development of next-generation smart structural components.

Synthesis and characterization of non-invasively traceable poly(ether urethane)s for biomedical applications

The ease of real-time visibility of biomedical implants and minimally invasive medical devices is indispensable in radiological imaging to avoid complications and assess therapeutic success. Herein, we prepared a series of polyurethane elastomers with inherent radiopacity, enabling them to be imaged under fluoroscopy. Through an appropriate selection of less toxic intermediates such as 1,6-Diisocyanatohexane (HDI), poly (tetramethylene glycol) (PTMG), and a chain extender, iodinated hydroquinone bis(2-hydroxyethyl) ether (IBHE), new radiopaque polyether urethanes (RPUs) containing about 10.8 to 20.6% iodine contents were synthesized. RPUs were characterized for the physicochemical, thermomechanical and radiopacifying properties. It was observed that the concentration of IBHE had a profound impact on the radiopacity of polyurethanes. RPUs exhibited similar or better radiopacity than an aluminum wedge of equivalent thickness. In-vivo imaging revealed that the RPUs were easily distinguishable from the surrounding tissues. Irrespective of iodine content, all the RPUs were cytocompatible, indicating the suitability of these materials for medical and allied applications.

PO-01-208 A COMPUTATIONAL MODEL TO TRACK CHANGES IN LEFT VENTRICULAR END-DIASTOLIC PRESSURE DURING ATRIAL FIBRILLATION

Heart failure and Atrial Fibrillation (AF) commonly occur concomitantly, resulting in significant morbidity and mortality. Thus, monitoring of heart failure status is essential in directing medical therapy in these patients. Left ventricular (LV) filling pressures are one of the most important parameters in assessing worsened or acutely decompensated left heart failure, however current LV pressure monitoring strategies include invasive devices and catheterization. Our study aims to develop a computational model of heart failure in AF and demonstrate that beat-to-beat variations in RR intervals during AF can be exploited to predict changes in LV filling pressure. We used a modified Research CardioVascular SIMulator (RCVSIM) human cardiovascular model to simulate an intact circulatory system in patients with AF over 300 seconds. To simulate beat-by-beat variation of rhythm in AF, the length of each RR-interval was drawn randomly from a Mixed Gaussian Distribution. We modelled worsening HF by changing LV end-systolic compliance in the simulator, using compliances ranging from 1 to 3.5 mL/mmHg, with interval increases in compliance of 0.1 mL/mmHg. Stroke volumes, RR-intervals, and LV end-diastolic pressures are recorded for each simulation. This was repeated for mean heart rates from 60 to 110 beats per minute. Stroke volumes were found to have a strong linear correlation with the previous beat’s RR-interval for all mean heart rates tested (Spearman rho = 0.9-0.97). In Figure 1 below, we show the slope of the RR-interval versus stroke volume (SV/RR-interval) plotted against average LV end-diastolic pressure for all LV systolic compliances noted above and a mean heart rate of 84 beats per minute. A cubic function fit to this plot shows excellent goodness-of-fit with the simulated data with a coefficient of determination (R2) of 0.99. This relationship remained consistent for all mean heart rates tested, and all cubic fits had R2 greater than 0.98. Our study provides a highly accurate model for estimating LV end-diastolic pressures over a broad range of LV systolic heart failure in simulated AF patients using only stroke volume and RR-intervals. Further work using photoplethysmography or continuous non-invasive arterial pressure (CNAP) monitoring could potentially be used to obtain these measures non-invasively, thus leading to a non-invasive method for tracking heart failure in patients with AF.

Epidemiology, Associated Factors, and Outcomes of Intensive Care Unit–Acquired Infections Caused by Multidrug-Resistant Organism in Critically Ill Patients

Abstract Background Nosocomial infections are a major health problem in the intensive care unit (ICU). Limited data exist on the epidemiology of ICU-acquired multidrug-resistant (MDR) microorganism infection. The study aimed to define the clinical characteristics, risk factors, and outcomes associated with the occurrence of an ICU-acquired MDR infection. Methods This is a retrospective, observational, single-center, case-control study, including all patients admitted to the unit between January 2015 and December 2019. Results During the study period, 3507 patients were admitted in the ICU. The overall incidence of ICU nosocomial infection was 9.6%, whereas the incidence of MDR infection was 0.9%, remaining stable throughout the study period. Based on multivariate analysis, only the presence of neutropenia on admission, days of mechanical ventilation, days with a urinary catheter, and ICU length of stay were identified as clinical factors independently associated with MDR infections. The occurrence of these infections was associated with increased length of stay and need for invasive devices, although there were no differences in associated mortality between groups. There was a 46% rate of pathogen-directed antibiotic treatment in cases of MDR infection, although when empirical treatment is used, MDR patients were less likely to receive initial appropriate antimicrobial therapy (25% vs 7%; P &lt; 0.001). Conclusions Multidrug-resistant infections presented a nonnegligible incidence and are associated with the existence of immunosuppression before admission, as well as the need for mechanical ventilation, urinary catheter, and prolonged ICU stay. They represent an increase in patient morbidity, although they are not related to an increase in mortality.

Validation of a Non-Invasive Method Using Mechanical Extensometer for the Estimation of Intracranial Compliance Using Repeated Measures Agreement Analysis (P11-7.001)

<h3>Objective:</h3> To validate a non-invasive intracranial (ICP) waveform monitoring device against the gold standard invasive ICP monitoring device for comparison of three methodologies calculating estimated intracranial compliance. <h3>Background:</h3> Cerebral compliance is the brain’s ability to accommodate volumes increases without an increase in pressure. Several methods utilize surrogate cerebral compliance estimations, but these require invasive ICP monitoring. For this study, intracranial compliance was calculated by transcranial doppler (TCD), as well as ICP waveform analysis (P1:P2 ratio, Time to Peak [TTP]). <h3>Design/Methods:</h3> Adult brain-injured patients were monitored with both invasive (extraventricular drain) and noninvasive (mechanical extensometer). TCD and ICP waveform analysis was performed by ICM+ and Brain4Care analytics. To examine agreement, a linear mixed-effects model accounted for repeated measurements to compute the concordance correlation coefficient (CCC), total deviation index (TDI), and coefficient of individual agreement (CIA). TCD values were log-transformed to mitigate non-normality. A coverage probability plot (CPP) was computed for the percent of observations within different cut points for each method. Computations were performed in R. All tests were two-sided and statistical significance was established at 0.05. <h3>Results:</h3> 21 patients were monitored for median 36 minutes (IQR 27–42). Agreement statistics for TCD, P2/P1 ratio, and TTP were as follows: TTP: [CCC 0.33; CIA 0.25; TDI, 95% agreement 0.24 units], P2:P1: [CCC 0.42; CIA 0.05; TDI, 95% agreement 1.05], and log(TCD): [CCC: 0.50; CIA: 0.04; TDI, 95% agreement 2.94]. Although the CCC was highest for log(TCD) values, TTP and P2:1 ratio had better agreement with TDI and CIA analysis. This was further supported by the CPP, which showed TTP had the highest percent of cases within various cutoff difference values. <h3>Conclusions:</h3> Non-invasive and invasive evaluations of estimated intracranial compliance reveals discordance between the three methodologies. ICP waveform derived measurements may be a better estimate of compliance compared to TCD-derived methods; however, prospective validation studies are required. <b>Disclosure:</b> An immediate family member of Dr. Williams has stock in Jazz Pharmaceuticals. Dr. Uysal has nothing to disclose. Nicholas Thompson has nothing to disclose. Ms. Hassett has nothing to disclose. Dr. Gomes has nothing to disclose.

Impact of an Accessory for Left Ventricular Assist Devices on Device Flow and Pressure Head In Vitro.

A novel accessory directing the blood from the outflow of a left ventricular assist device (LVAD) back through the left ventricular apex and across the aortic valve allows LVAD implantation via the left ventricular apex solely but may affect the LVAD performance. We quantified the effect of the accessory on LVAD flow and pressure head in vitro. In a mock circulatory loop, a centrifugal-flow LVAD (HeartMate 3, Abbott, Abbott Park, IL, USA) with (Accessory) and without the accessory (Control) was compared under physiological conditions using a water/glycerol solution as a blood substitute. The pump was operated at 4000, 5200, and 6400 rpm and 5 different resistance levels. Flow, inlet, and outlet pressure were measured, and pressure head was calculated. Compared to the Control, flow and pressure head in the Accessory group were reduced by an overall average of 0.26 L/min and 9.9 mmHg (all speeds and resistance levels). The highest decline in flow and pressure head occurred at the lowest resistance levels. In conclusion, the accessory leads to a reduction of LVAD flow and pressure head that is enhanced by decreases in resistance. Future developments in the LVAD accessory's design may reduce these effects and allow unimpaired LVAD performance and minimally invasive device implantation.

Combination drug strategies for biofilm eradication using synthetic and natural agents in KAPE pathogens.

Antibiotic resistance is a global threat caused by factors such as overuse of antibiotics, lack of awareness, development of biofilms etc. World Health Organization released a list of global priority pathogens which consisted of 12 species of bacteria categorized as expressing critical, high and medium resistance. Several Gram-negative and Gram-positive species are known to cause wide varieties of infections and have become multidrug or extremely drug resistant. Pathogens causing infections associated with invasive medical devices are biofilm producers and hence their treatment becomes difficult due to a structurally stable matrix which prevents antibiotics from penetrating the biofilm and thereby showing its effects. Factors contributing to tolerance are inhibition of penetration, restricted growth and activation of biofilm genes. Combination drug therapies has also shown potential to eradicate biofilm infections. A combination of inhaled Fosfomycin/tobramycin antibiotic strategy has been effective against Gram-negative as well as Gram positive organisms. Along with antibiotics, use of natural or synthetic adjuvants shows promising effects to treat biofilm infections. Fluroquinolone activity on biofilms is disrupted by low oxygen tension in the matrix, a strategy known as hyperbaric oxygen treatment that can enhance efficacy of antibiotics if well optimized. Adjuvants such as Ethylenediaminetetraacetic acid (EDTA), Sodium Dodecyl Sulphate (SDS) and chlorhexidine act by killing non-growing microbial cells aggregated on the inner layer of the biofilm. This review aims to list down current combination therapies used against Gram-negative and Gram-positive biofilm forming pathogens and brief about comparison of combination drugs and their efficacies.

Promoting appropriate midline catheter and PICC placement through implementation of an EHR-based clinical decision support tool: An interrupted time-series analysis.

Inappropriate use of peripherally inserted central catheters (PICCs), including multilumen PICCs, may increase the risk of patient complications. Implement computerized decision support to: (a) increase the use of midline catheters over PICCs when appropriate and (b) decrease PICC lumens when a PICC is necessary. Quasi-experimental, interrupted time series. Single tertiary academic medical center. Hospitalized adults who received a midline or PICC during clinical care. Decision support on appropriate vascular access device choice via a set of electronic orders embedded within the electronic health record. Proportion of midline catheter and single-lumen PICCs placed between January 2, 2017 and November 19, 2017 (preintervention) versus November 20, 2017 to December 1, 2019 (postintervention). A total of 8758 midline and PICCs were inserted during the study period. A statistically significant increase in the insertion of midline catheters was observed during the intervention (p = .006). In parallel, single-lumen PICC insertion as a proportion of all PICCs also increased after the intervention (p = .035). Results were consistent across multiple disciplines, including internal medicine, surgery, and intensive care. After considering the hospital census, total PICC and midline utilization rates and rates of complications did not change over time. However, an increase in catheter exchanges from less to more invasive devices occurred. In this single-center study, the implementation of electronic decision support to inform appropriate catheter use led to a more appropriate midline catheter and single-lumen PICC insertion. Dissemination of this single, effective intervention to examine efficacy in other hospital settings would be welcomed.

Surgical Treatment for Epilepsy: An Updated Summary of Treatment Modalities and Clinical Evidence

The efficacy of surgical treatment for drug-resistant epilepsy has been proven based on accumulated evidence, such as several randomized controlled trials. There are emerging treatment modalities, including less invasive surgical techniques and neuromodulation devices, which have also been proven to benefit patients by improving seizure control. A recent methodological shift from subdural electrocorticography recordings to stereo-encephalography recordings for intracranialelectroencephalography (iEEG) monitoring has also positively impacted clinical decision-making. Although some of these newer modalities are yet to be implemented in Japan, this article provides updated evidence and a summary of the currently available options for surgical treatment of patients with drug-resistant epilepsy. We hope that this summary will widen the treatment opportunities for patients with this highly impactful disease.

Epidemiology of Serratia marcescens infections in NICU of a Teaching and Research Hospital in Northern Italy.

Serratia marcescens (Sm) is a known cause of infection and colonization in neonates receiving intensive care. The aim of this study was to identify the risk factors for colonization and infection with Sm in Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital. A case-control study was conducted from January to December 2011 in neonates admitted to the NICU. Cases are patients with a microbiologically confirmed infection or colonization, controls were randomly chosen among patients admitted to the same NICU. Globally, 39 acquired infections or colonizations were identified. Among factors related to pregnancy, only premature delivery was independently associated to the risk of infection; as well as mechanical ventilation and catheterization for parenteral nutrition, considering indwelling devices. Prolonged administration with antibiotics were also related to the risk of infection. Among Sm strains which have been tested to antibiotics, all have been resistant to amoxicillin/clavulanic acid and to colistin. This study confirms the association between Sm infection or colonization and low gestational age. Invasive medical devices and medications, strictly necessary in care-support of preterm neonates, are likely related to Sm infection too. Preventive control strategies are expected to be effective in the control of Sm spread in NICUs.

MP76-02 AT 4 YEARS, OPTILUME BPH HAS THE HIGHEST SUSTAINED IMPROVEMENT IN PEAK FLOW (QMAX) OF ANY MINIMALLY INVASIVE BPH THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP76-02 AT 4 YEARS, OPTILUME BPH HAS THE HIGHEST SUSTAINED IMPROVEMENT IN PEAK FLOW (QMAX) OF ANY MINIMALLY INVASIVE BPH THERAPY Steven Kaplan, Merycarla Pichardo, Edwin Rijo, Ramon Rodriguez Lay, Gustavo Espino, and Rafael Estrella Steven KaplanSteven Kaplan More articles by this author , Merycarla PichardoMerycarla Pichardo More articles by this author , Edwin RijoEdwin Rijo More articles by this author , Ramon Rodriguez LayRamon Rodriguez Lay More articles by this author , Gustavo EspinoGustavo Espino More articles by this author , and Rafael EstrellaRafael Estrella More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The EVEREST-I study is a prospective, single arm, multicenter study evaluating functional improvement in urine flow and improvement in lower urinary tract symptoms (LUTS) after treatment with the Optilume BPH System, a novel minimally-invasive treatment for Benign Prostatic Hyperplasia (BPH). Optilume BPH utilizes mechanical dilation of the prostatic urethra to achieve an anterior commissurotomy while delivering the drug paclitaxel to maintain long-term urethral patency. METHODS: A total of 80 subjects were enrolled at 6 centers. Follow up is ongoing, with 32 of 72 expected subjects with 4-year follow-up complete. Symptom improvement was measured utilizing the International Prostate Symptom Score (IPSS) and BPH Impact Index (BPH-II), functional improvement measured by peak urinary flow rate (Qmax) and post-void residual volume (PVR). RESULTS: Mean Qmax showed an immediate increase from 10.9 mL/sec at baseline to 18.8 mL/sec at 14 days, which was sustained at 18.1 mL/sec through 4 years post treatment (p<0.001 vs baseline). A paired analysis of those subjects completing the 4-year visit showed a steady Qmax compared to 3-year outcomes (18.1 vs 18.8, p=0.54). IPSS and BPH-II showed significant, immediate improvement from baseline with this improvement maintained through the 4-year follow-up (Table 1). Erectile and ejaculatory function scores were not significantly changed from baseline through 4 years. CONCLUSIONS: The Optilume BPH Catheter System combines mechanical and pharmaceutical aspects for the treatment of BPH, resulting in both an immediate functional improvement by way of creating an anterior commissurotomy and a sustained anatomic result due to the application of paclitaxel to the prostatic urethra during the initial dilation. The functional and symptomatic improvements seen after treatment with Optilume BPH have been sustained through 4 years in this early feasibility study. The sustained improvement in Qmax is superior to any minimally invasive BPH device currently approved. Results from the EVEREST study will be further verified in the ongoing randomized, sham controlled PINNACLE study. Source of Funding: This study was funded by Urotronic, Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1090 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Kaplan More articles by this author Merycarla Pichardo More articles by this author Edwin Rijo More articles by this author Ramon Rodriguez Lay More articles by this author Gustavo Espino More articles by this author Rafael Estrella More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimally invasive intracerebral hemorrhage evacuation: A bibliometric analysis of current research trends

Intracerebral hemorrhage (ICH) is associated with significant morbidity and mortality. Randomized clinical trials focusing on minimally invasive surgery (MIS) for ICH evacuation have suggested a potential benefit regarding mortality but results remain unclear regarding impact on functional outcome. This study presents a bibliometric analysis investigating the current trends in the literature on MIS for ICH. Using the Scopus collection database, a search was performed to identify literature that discussed MIS for ICH from 2000 to 2021. Primary research articles were included in this study. Reviews and book chapters were excluded. Analysis and visualization of the included literature were completed with VOSviewer. A total of 278 articles were identified. An upward trend in publications began in 2008, with the most publications in 2021 (36) followed by 2020 (25). The most citations occurred in 2013 (1192). The h-index, i-10 and i-100 were 37, 79 and 6 respectively. For the top 100 most cited studies, the mean citation count was 45.55 with a range of 6-760. The highest-producing institutions of MIS for ICH literature were Johns Hopkins University (31, 15 %), University of Chicago with (21, 10 %), Guiyang Medical College (17, 8 %), and Icahn School of Medicine at Mount Sinai (15, 7 %). Keyword analysis revealed four major avenues: 1) medication enhancement of clot removal, 2) minimally invasive devices such as endoscopes, 3) craniotomy approach, and 4) physiology of clot removal. The literature on MIS for ICH has been expanding since 2008. Key topics include thrombolysis, device innovation, and surgical approach.

Epidemiological features of septic nosocomial infections within various intensive care units

Septic nosocomial infections are a major public health issue. Both the risk of contracting and the specificity of nosocomial pathology directly depend upon the type of inpatient settings, as well as on the institution-specific risk factors. Material and methods: The study used a descriptive observation method based on a cross-sectional study. The present research documented and analysed retrospectively 687 follow-up records of patients admitted to different intensive care units. Results: The study results found that the incidence of septic nosocomial infection within various intensive care units (ICU) differs, ranging between 24.68% up to 34.8%. The structure of nosological forms was dominated by severe infections as pneumonia – 50.7%, septicemia – 12.68%, surgical site infections – 12.60%, urinary tract infections – 8.45%. The polyetiological structure of pathogens varied depending on the types of ICU. Microorganisms of the genus Staphylococcus, Acinetobacter, Clebsiella, Pseudomonas and Enterobacter predominated in most gram-negative (87.25%) cases, being multidrug resistant to antibiotics. The following risk factors for the development of nosocomial septic infections were identified: the widespread use of invasive devices in the treatment process, patient’s comorbidities, polytraumas, vasopressors administration, the length of hospital stay within the ICU, etc. The clinical and economic effect is also important; hence the hospital stay length of patients with nosocomial infections was 2.2-2.5 times, the hospital stay cost per patient was 4.56 times, and the mortality rate was 4.55-8.43 higher compared to patients with no purulent nosocomial infections. Conclusions: Septic nosocomial infections are an urgent issue for ICU admission, which requires the implementation of comprehensive programs to prevent morbidity and reduce microbial antibiotic resistance.