Normal Functional Status Research Articles

Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach With Intraoperative Ultrasound Guidance.

The disc location, extent of calcification, limited visualization of the ventral cord, and tenuous blood supply to the thoracic spinal cord pose unique technical challenges when surgically treating thoracic disc herniation. To report our initial experience with a series of cases in which intraoperative ultrasound image guidance was used for thoracic discectomy through a unilateral transpedicular or costotransversectomy approach. Five patients (n=5) underwent a transpedicular approach and five (n=5) underwent costotransversectomy for thoracic discectomy. Pre- and postoperative clinical records, operative reports, disc location/calcification, and complications were reviewed. There were 6 (n=6) males and 4 (n=4) females with an average age of 54 yr (range: 33-74). All patients had symptoms attributable to a single-level of thoracic disc herniation. Discs were classified as central (n=5) and paracentral (n=5). Preoperative CT and/or intraoperative visualization demonstrated calcified disc material in 6 (n=6) patients. Final outcomes data at last follow-up was available for 9 of 10 patients. Eight of these nine patients experienced a return to normal baseline functional status. Postoperative imaging confirmed that no wrong-level surgeries were performed. The mean length of follow-up was 20.4 wk (range 4-48). Thoracic discectomy with ultrasound visualization via a unilateral transpedicular or costotransversectomy approach is safe and effective for treatment of central and paracentral calcified disc herniations. This tool improves the safety profile of thoracic discectomy and allows for treatment of thoracic discs through less invasive approaches.

SAT-466 Cases of Acromegaly and Presumed Prolactinoma in Setting of Empty Sella Syndrome: Presentation and Management Implications

Introduction; Empty Sella syndrome (ESS) is an uncommon finding on brain imaging whose functional significance remains controversial. While sometimes associated with pituitary hypofunction it is far less commonly associated with pituitary hyperfunction syndromes. We present two cases of this; one with acromegaly and one of hyperprolactinemia presumably due to prolactinoma both associated with ESS on brain imaging. Clinical Cases; A 48 yr old man was evaluated on account of reduced libido and chronic fatigue which revealed hypogonadotrophic hypogonadism. Further work up revealed prolactin levels in the 250-300ng/ml range. Brain MRI showed ESS and the rest of the pituitary hormone functional work up was normal. Bone density showed osteopenia and octreotide scan showed no sella enhancement nor other anomalies. When commenced on cabergoline 0.5mg 2 x wkly his prolactin levels normalized over 6 months and the hypogonadism resolved without requiring androgen replacement. A 49 yr old gentleman with long standing hypogonadotrophic hypogonadism on androgen replacement presented with persistent headaches and generalized arthralgias. He had clinical features suggestive of acromegaly including macrocephaly, macroglossia, facial dysmorphia and enlarged hands and feet. Diagnosis was confirmed by elevated IGF-1 (300-400ng/ml range), growth hormone levels and non suppressible growth hormone on Oral glucose tolerance test. No other pituitary functional deficits were found. Brain MRI showed ESS and octreotide scan showed no sella enhancement nor other anomalies. His IGF-1 levels normalized with octreotide LAR 20mg monthly. His androgen repletion also improved with lower testosterone dose requirement along with improvement in headaches and arthralgias though he developed type 2 diabetes. Results and Discussion; Review of our system's clinical records over the prior 5 years revealed 307 cases of ESS. 10 had hypopituitarism, 6 had hypogonadism, 12 had hyperprolactinemia presumed due to prolactinoma, 1 each had central hypothyroidism, acromegaly and diabetes insipidus. 276 (92%) of cases had normal pituitary functional status. Concluding remarks; ESS is an uncommon but important imaging finding on brain imaging. Though most patients with ESS have normal pituitary function it may be associated with pituitary hypofunction or even hyperfunction states. Its finding in pituitary hyperfunction states like hyperprolactinemia and acromegaly make medication therapy the only viable treatment option as surgery and radiotherapy have no visible target to direct therapy.

Abstract TP268: Utilization and Appropriateness of Emergency Medical Services Air Transport in Acute Ischemic Stroke Care

Introduction: Although air (helicopter) transfer is largely accepted as improving outcomes in time sensitive conditions including acute ischemic stroke (AIS), inappropriate triage of these patients when they are ineligible for acute stroke therapies places patients and providers at unnecessary risk and wastes limited healthcare resources. Extension of the endovascular therapy time window to twenty-four hours further increases the burden on stroke systems of care. As the tertiary flagship institution and only comprehensive stroke center (CSC) in a rural state, we sought to identify how accurate our triage system was at identifying ischemic stroke patients appropriate for air transfer. Hypothesis: A significant percent of AIS patients inappropriately utilize HelicopterEmergency Medical Services (HEMS). Based on information known prior to transfer, the majority are avoidable. Methods: We defined inappropriate utilization basedon time from last known normal (LKN), stroke severity and baseline functional status. A retrospective chart review was performed on all stroke alerts that arrived at our hospital by HEMS in 2017. Results: Of the 141 acute stroke patients transferred by HEMS, 23 (16%) were deemed inappropriate; 14 (61% ) were outside the acute treatment time windows for either IV tPA or Endovascular Therapy (EVT); 5(22%) were ineligible for EVT (NIHSS<6); 2 (9%) were ineligible for EVT (mRS≥3); and 2 (9%) were flown despite negative angiographic studies performed at transferring institution. At an average cost of $18,500/flight, $425,500 in total was attributed to inappropriate transport. Thirteen (57%) of the patients were interfacility transfers where the decision to arrange HEMS occurred after a physician’s evaluation. Conclusion: HEMS transport for AIS patients plays a crucial role in delivering the best care. However, a significant percent of patients do not meet criteria for its appropriate utilization, most commonly when pre-established LSN are outside of acute treatment windows. Furthermore, inappropriate transfers were initiated in spite of outside hospital physician evaluation over 50% of the time. These results represent a unique opportunity to coordinate education and buildeffective triage paradigmsacross a system of stroke care.

Comparison of clinical and functional outcome of intra-articular fractures of distal end of radius with conservative versus surgical treatment: A prospective study

A prospective study constituted a total of n = 90 subjects with intra-articular distal end of radius fractures was conducted in Kakatiya Medical College, Warangal, Telangana, India, for a period of eighteen months. The objective of the present study was management for a distal end radius fracture for accurate restoration of range of motion and grip strength and to achieve a good functional outcome with return to normal functional status of the patient at the earliest possible and to compare clinical and functional outcome with conservative and surgical management. The present study sample consisted of n = 90 subjects of which n = 44 subjects were treated with conservative management, n = 46 with surgical method. Among n = 46 cases treated surgically, n = 11 were managed by pinning, n = 11 by ligamentotaxis with external fixator and n = 24 with plating. Excellent results were observed in 30% of the cases in conservative group and 47.5% in surgical group. Excellent and good results were seen in 85% cases in plating group and 52.17% in K-wire in surgically managed group. Excellent and good outcome results in conservative group were observed in stable, minimally comminuted and minimally displaced fracture pattern. Excellent and good outcome results were seen in many of such fracture pattern among surgical group. The best outcome or results were seen among young individuals.

PO294 Treatment of Acute Bilateral High Risk Pulmonary Embolism Through Bilateral Thrombectomy Using a jr 8 Fr Guiding Catheter and Use of a Bilateral Ultrasound-Assisted Catheter-Directed Thrombolysis (EKOS) For 12 hrs.

Thrombolytics and extracorporeal membrane oxygenation (ECMO) are potential management options for massive pulmonary embolism (PE). There are early data supporting the use of repeated alteplase 50 mg bolus for massive PE. However, there is sparse literature addressing placement of ECMO catheters after systemic thrombolysis, and there are no reports of initiating ECMO after repeated bolus of alteplase. We present the case of a patient with massive PE who received two boluses of alteplase for recurrent cardiac arrest, followed by initiation of ECMO. The patient stabilized with these interventions, and ultimately had a good outcome with normal neurologic and functional status.

Functional recovery after surgical stabilization and postoperative radiotherapy due to metastases of long bones

PurposeTo reinvestigate the functional recovery after combined treatment with surgery and postoperative irradiation of complete or impending pathologic fractures of long bones.MethodsWe retrospectively evaluated the results of external beam radiation therapy (EBRT) carried out after 68 orthopedic stabilization procedures (femur, n = 55, 80.8%; humerus, n = 13, 19.2%) for actual or impending pathological fracture of long bone in 61 patients with skeletal metastases. The mean normalized total dose was 34.7 ± 7.8 Gy. Endpoints were patient’s functional status (FS; 1 = normal pain free status; 2 = normal use with pain; 3 = significantly limited used; 4 = nonfunctional status), a need for a secondary procedure to the same site and overall survival following surgery.ResultsOverall, 75% of patients achieved normal functional status (FS 1–2) within 12 weeks after surgery. Functional recovery in surviving patients reached 93%. Median survival was 17 months (95% confidence interval 13.7–20.2). Secondary surgical intervention at the same location was necessary in 3 patients (4.4%). On multivariate analysis, only general status (p = 0.011) and growing potential of primary tumor (p = 0.049) were associated with achieving normal functional status within 12 weeks after surgery and radiotherapy. The applied radiation schemes demonstrated a comparable impact on functional recovery.ConclusionsOur results confirm the effectiveness of stabilizing surgery and fractionated postoperative radiotherapy in terms of functional recovery, supporting prior results assessing postsurgical radiotherapy versus follow-up. The patient’s general status is a strong prognostic factor for functional recovery. Rapidly growing tumors may hinder achievement of a normal functional status.

Case report: new onset heart failure in congenitally corrected transposition of the great arteries, dextrocardia, and situs inversus in an octogenarian

BackgroundCongenitally corrected transposition of the great arteries (ccTGA) is a rare anomaly comprising a minimal portion of congenital heart disease cases. Some patients are not identified until adulthood. A minority of these patients maintain normal functional status into the seventh decade and generally only when no other anomalies exist. We describe a case of ccTGA, dextrocardia, and situs inversus in the oldest patient diagnosed with these congenital abnormalities to date.Case presentationAn 83 year old female with known dextrocardia presented with dyspnea and was diagnosed with ccTGA, situs inversus, and new onset heart failure.ConclusionsThe factors that lead to a delayed presentation of systemic right ventricular failure in ccTGA remain ill-defined. Common adult acquired secondary causes of heart failure, such as hypertension and coronary artery disease, likely play a role in patients with congenital heart disease. Aggressive screening and management of these co-existing diseases may improve overall outcomes in adult patients with congenital heart disease.

Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests.

Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.

Study II on Chrozophora oblongifolia Aerial Parts: Assessment of Antioxidant Activity, Hepatoprotective Activity and Effect on Hypothalamic-gonadal Axis in Adult Male Rats

Objectives: The present study aimed at the investigation of antioxidant activity, hepatoprotective activity in addition to the effect on hypothalamic-gonadal axis in adult male rat of total methanolic extract and different fractions of Chrozophora oblongifolia aerial parts. Methods: Antioxidant activity was evaluated by DPPH spectrophotometric method, Hepatoprotective activity was evaluated using CCl4 induced liver damage method by measuring serum marker enzymes, SGOT, SGPT and total bilirubin. The effect on hypothalamic-gonadal axis in adult male rats was estimated by measuring serum level of testosterone, follicle stimulating hormone and leutinizing hormone by immune enzymatic assay kit using ELISA reader. Results: The methanol fraction showed highest antioxidant activity followed by total extract and ethyl acetate fraction concentrate, while the methylene chloride and n-hexane fractions showed lowest antioxidant activity. The total methanolic extract in addition to ethyl acetate and methanol fractions exhibited significant decrease in SGOT and SGPT enzymes and total bilirubin, indicating their effectiveness in protecting the liver normal functional status. The total methanolic extract of aerial and fruit parts, each showed marked increase in serum level of total testosterone, follicle stimulating hormone and leutinizing hormone, when administered orally for 28 successive days compared to control group. Conclusion: Total methanol extract of the aerial parts of Chrozophora oblongifolia has significant antioxidant and hepatoprotective activities. Also extract of aerial parts including fruits has increased rat serum level of gonads, suggesting Chrozophora oblongifolia, as a valuable biological source of drugs enhances fertility.

Multiple limb salvage attempts for diabetic foot infections: is it worth it?

Limb salvage for diabetic foot infections often require multiple procedures. Some patients will eventually end up with below knee amputation (BKA) when all limb salvage attempts fail. We seek to study the patients' ability to return to normal life, functional status, prosthesis usage and perspectives on multiple limb salvage procedures that culminated in BKA to review if they would undertake a similar path if their situation was repeated. A total of 41 patients who underwent BKA between July 2011 and June 2013 were reviewed. They were divided into primary and creeping (prior multiple salvage procedures) amputations. The Barthel's Index (BI) and the Reintegration to Normal Living Index (RNLI) were used. A questionnaire was used to identify whether the patient would undergo the same multiple attempts at limb salvage again if faced with the same problem. All patients had a good mean BI of 14.2 (3 to 20) and RNLI of 73.2 (31 to 100). There was no difference in prosthesis usage, BI and RNLI between both groups. We found that 16 (94.1%) out of 17 patients with creeping amputation would undergo the same multiple salvage procedures if given a similar option. Conversely, only 15 (62.5%) patients with primary amputation would do the same again while the other nine (37.5%) patients choose to do everything possible to save their leg if faced with a similar situation (p = 0.001). Most patients preferred to undergo multiple procedures to salvage the limb from diabetic foot infection even if it ultimately concluded with a BKA. All the patients had a moderately good functional outcome and ability to return to normal living after BKA. Cite this article: Bone Joint J 2017;99-B:1502-7.

EXPLORATION OF GOITROGENIC/ANTITHYROIDAL POTENTIALITY OF BAMBOO-SHOOTS IN RELATION TO THIOUREA

Objective: Natural goitrogens present in plant foods or antithyroidal drugs both alter the morphology and normal functional status of the thyroid gland interfering the synthesis and secretion of thyroid hormones. In this study, the goitrogenic potential of bamboo shoots (BS) containing natural goitrogens has been compared against a potent synthetic antithyroidal drug thiourea.Methods: BS was fed to 6 rats by 1/3rdreplacement of 180grams (g) of their food i.e.60g of BS containing 35g of goitrogens of cyanogenic origin such that each rat ideally consumed 6 mg/100g of body weight per day and thiourea at a near equal dose of 6 mg/100g of body weight per day was force fed to another 6 rats for a period of 45 d. Changes in food consumption pattern, serum toxicity marker SGOT and SGPT, morphological changes like thyroid gland weight and histology and functional aspects like TPO activity, Na+-K+ATPase activity, urinary iodine excretion and serum T3,T4 and TSH levels induced by this natural and synthetic agent respectively were investigated. Results analyzed by ANOVA followed by post hoc tests.Results: Food consumption pattern was similar in all groups while serum toxicity markers SGOT, SGPT showed a non-significant increase in experimental groups. Increase in body and thyroid gland weight as compared to control was seen on treatment with both antithyroidal agents, a greater percentage of increase was seen in thiourea treated group. TPO activity, Na+-K+ATPase activity, serum T3 and T4levels were decreased significantly in both treated groups as compared to normal, with maximum inhibition in the thiourea treated group. Histological plates of BS treated thyroid revealed hypertrophy and thyroid follicular cell disruption with microcytic infiltration. Thiourea treated gland histological plate revealed complete abolition of normal histoarchitecture with marked changes in colloidal area and hyperplasia with folding and papillae on the epithelium.Conclusion: In overall, the data indicate that though the goitrogenic potentiality of BS cannot be considered having similar efficacy to that of thiourea but as a food entity by itself, it has potent antithyroidal activity even in presence of adequate iodine intake.

Normal carboxyhaemoglobin level in carbon monoxide poisoning treated with hyperbaric oxygen therapy

Throughout the world both intentional and inadvertent exposure to carbon monoxide (CO) remains an important public health issue. While CO poisoning can be lethal, the morbidity is predominantly due to...

The Case Files

The Case Files

Functional Status Scale in Children With Traumatic Brain Injury: A Prospective Cohort Study.

In children with traumatic brain injury, 1) to describe the hospital discharge functional outcome and change from baseline function using the Functional Status Scale and 2) to determine any associations between discharge Functional Status Scale and age, injury mechanism, neurologic examination, imaging, and other predictors of outcome. Prospective observational cohort study, May 2013 to November 2015. Two U.S. children's hospitals designated as American College of Surgeons level 1 pediatric trauma centers. Children less than 18 years old admitted to an ICU with acute traumatic brain injury and either a surgical or critical care intervention within the first 24 hours or in-hospital mortality. None. The primary outcome was hospital discharge Functional Status Scale. Most, 133 of 196 (68%), had severe traumatic brain injury (admission Glasgow Coma Scale, 3-8). Overall hospital mortality was 14%; 20% among those with severe traumatic brain injury. Hospital discharge Functional Status Scale had an inverse relationship with Glasgow Coma Scale: for each increase in admission Glasgow Coma Scale by 1, the discharge Functional Status Scale decreased by 0.5 (95% CI, 0.7-0.3). Baseline Functional Status Scale was collected at one site (n = 75). At that site, nearly all (61/62) of the survivors had normal or near-normal (≤ 7) preinjury Functional Status Scale. More than one-third, 23 of 62 (37%), of survivors had new morbidity at hospital discharge (increase in Functional Status Scale, ≥ 3). Among children with severe traumatic brain injury who had baseline Functional Status Scale collected, 21 of 41 survivors (51%) had new morbidity at hospital discharge. The mean change in Functional Status Scale from baseline to hospital discharge was 3.9 ± 4.9 overall and 5.2 ± 5.4 in children with severe traumatic brain injury. More than one-third of survivors, and approximately half of survivors with severe traumatic brain injury, will have new morbidity. Hospital discharge Functional Status Scale, change from baseline Functional Status Scale, and new morbidity acquisition can be used as outcome measures for hospital-based care process improvement initiatives and interventional studies of children with traumatic brain injury.

Abstract: Locoregional Microbiology Differs by Mechanism, Location, Type, and First Intervention at Initial Evaluation: Novel Findings in Hand Infection Epidemiology

INTRODUCTION: Hand infections confer significant functional morbidity due to prolonged recovery, loss of time at work, and diminished ability with activities of daily living. Prior investigations have focused exclusively on patients who were operated on. Delineating the locoregional microbiology of hand infections, including patients drained non-operatively who may have a different pathologic microbiome, can lead to a superior understanding of infection epidemiology and optimize initial antibiotic regimen. MATERIALS AND METHODS: A prospective registry enrolled surgical hand infection patients. Infections were categorized by mechanism, location, and type. Patients were stratified by first intervention at initial evaluation. Chi-squared analysis compared microbiology by covariate. RESULTS: 177 patients presented with a total of N = 238 culture results. Mechanisms were as follows: 5% burn, 4% fight bite, 34% trauma, 17% IVDA, 10% animal bite, 1% cancer-related, 2% dermatologic lesion, 1% sepsis, 1% foreign body, and 44% idiopathic. Locations occurred as follows: 10% thumb, 50% digit, 22% hand, 23% wrist, 20% forearm. Type was as follows: 9% paronychia, 5% felon, 57% abscess, 4% tenosynovitis, 5% osteomyelitis, 2% fasciitis, 18% joint. At initial evaluation, 23% were discharged after bedside drainage, 11% were admitted without drainage, 26% were admitted after bedside drainage, while 40% went to the OR. From cultures, 71% grew Gram-positive microorganisms, 13% Gram-negative, 1% fungal, 5% few mixed, and 11% showed no growth. The overall prevalence of Staph aureus was 41%, with 19% MRSA. The prevalence of Staph aureus was significantly different in patients with mechanisms that were traumatic (51%, p=0.03), IVDA (18%, p<0.01), animal bites (21%, p<0.03), and idiopathic (62%, p<0.01), in locations in the digits (51%, p<0.01), wrist (23%, p=0.05), and forearm (20%, p<0.01), in infection types that were felon (69%, p<0.04) and joint (28%, p=0.05), and in patients who went to the OR at initial evaluation (30%, p<0.01). CONCLUSIONS: These findings suggest that our locoregional infection microbiology varies significantly by mechanism, location, type, and in patients initially triaged for operative drainage. Coupled with sensitivity data, these findings can develop a risk-stratified, optimized algorithm for initial empiric antibiotic choice at presentation as a function of mechanism, location, type, and triage, which could potentially reduce inpatient length-of-stay and hasten recovery to normal functional status in this patient population. DISCLOSURE/FINANCIAL SUPPORT:None

Functional status as a predictor of outcomes in open and endovascular abdominal aortic aneurysm repair

BackgroundFunctional status is a simple and rapidly assessable metric that may be used as a predictor for surgical outcomes. This study examined the association of functional status with short-term mortality after abdominal aortic aneurysm (AAA) repair in octogenarians to characterize the utility of functional status as a means of preoperative risk assessment. MethodsAll patients who underwent endovascular and open AAA repair from 2002 to 2010 within the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database were identified. Functional status, defined as an ordinal scale from 1 to 3 (1, independent; 2, partially dependent; 3, totally dependent), was examined using multivariate regression models with 30-day mortality as the primary outcome. For the purpose of analysis, this 3-point scale was converted into a binomial scale of function, with “normal” including 1 (completely independent) and “abnormal” including 2 or 3 (partially to totally dependent). ResultsWe identified 9030 patients who underwent AAA repair (46.6% open and 53.4% endovascular). Mortality at 30 days was 2.8% for the entire cohort (4.2% open, 1.7% endovascular; P < .001). There were 1340 patients aged ≥80 years, of which 67.3% underwent endovascular AAA repair. Among all age groups, functional status was a significant predictor of 30-day mortality (<80 years, P < .001; ≥80 years, P < .001). The ≥80 cohort with abnormal function status also demonstrated increased operative mortality (P = .002), length of stay (P = .001), and incidence of pulmonary complications (P = .025) compared with the cohort with normal functional status. Multivariate logistic regression demonstrated that within the ≥80-year-old cohort, only functional status remained a significant predictor of mortality (P < .001). In addition, the strength of the association between functional status and mortality was greater in the older cohort than in the younger one (Cox regression hazard ratio: 3.13 vs 2.18). ConclusionsFunctional status is a simple and rapidly applicable predictor of mortality within AAA patients and may be a useful tool to help preoperatively risk-stratify elderly patients presenting with AAA in need of repair. Further studies are needed to understand how best to apply these data to the clinical setting to guide preoperative decision making.

Cardiovascular implantable electronic device function and longevity at autopsy: an underestimated resource

The feasibility and safety of postmortem cardiovascular implantable electronic device (CIED; pacemaker or defibrillator) retrieval for reuse has been shown. To date, studies indicate a low yield of reusable postmortem CIEDs (17%-30%). The purpose of this study was to test the hypothesis that a higher rate of reusable CIEDs would be identified upon postmortem retrieval when an institutional protocol for systematic and routine acquisition, interrogation, reprogramming, and manufacturer analysis was used. Over a 6-year period, all subjects referred for autopsy underwent concomitant CIED pulse generator retrieval and enrollment in the Johns Hopkins Post-Mortem CIED Registry. CIEDs were interrogated, reprogrammed, and submitted for manufacturer analysis. In total, 84 autopsies had CIEDs (37 pacemakers, 47 implantable cardioverter-defibrillators). CIEDs were implanted 2.84 ± 2.32 years before death, with 30% implanted <1 year before death. Overall, CIED postmortem longevity was 4.79 ± 3.41 years, with 56% demonstrating longevity ≥4 years (this group had an estimated mean longevity of 7.37 ± 2.44 years). Manufacturer analyses uncovered 2 falsely triggered elective replacement indication alerts, confirmed 5 correctly triggered elective replacement indication alerts, identified a recalled pacemaker, and verified that a defibrillator had undergone nonprogrammable hard reset. When a protocol for systematic and routine postmortem CIED retrieval, interrogation, reprogramming, and analysis was used, we noted that >60% of pacemakers and >50% of defibrillators demonstrated normal functional status with projected longevities >7 years on average. Formation of a national hospital-based "CIED donor network" would facilitate larger scale charitable efforts in underserved countries.

Abstract 125: Vitamin D3-Induced Arterial Calcification Decreases Functional Recovery and Limb Perfusion in a Murine Model of Hindlimb Ischemia

Objectives: Clinical studies demonstrate associations between arterial calcification and adverse outcomes in patients with peripheral arterial disease. The causal relationship between calcification and ischemia, however, remains unclear. This study aims to evaluate the effects of arterial calcification on functional recovery and limb perfusion following acute limb ischemia in a murine model. Methods: Arterial calcification was induced in 64 Sprague-Dawley rats using Vitamin D 3 . A control group of 32 rats received vehicle only. After 2 weeks, to allow for calcification, unilateral hindlimb ischemia was induced by ligation and excision of the superficial femoral artery. At weekly intervals, functional and ischemia status were evaluated in a blinded manner and laser Doppler perfusion imaging was performed. Results: Calcium assay demonstrated greater arterial calcification in the superficial femoral arteries (0.1 vs. 17.0, P &lt; .01) of Vitamin D 3 injected animals. Rats injected with Vitamin D3 showed significantly worse Tarlov, Ischemia, Modified Ischemia, and Total Ischemia scores at each post-operative time point (Week 1: 16.6 vs. 14.5 P &lt;.01, Week 2: 17.1 vs. 14.5 P &lt;.01, Week 3 17.5 vs. 15.0 P &lt; .01). The control group regained normal functional status by week 4; however Vitamin D3-injected rats did not return to baseline by the conclusion of the study (17.9 vs. 16.6, P &lt; .01). Laser Doppler perfusion revealed decreased raw perfusion values pre-operatively (616 vs. 428, P &lt; .01) and at weekly intervals beginning at week 2 in both the ischemic and non-ischemic limbs among animals with calcified arteries as compared to controls (Table 1). Conclusions: Vitamin D3 induced calcification is associated with decreased perfusion and worse functional recovery in a rat model of hindlimb ischemia. Future research aimed at understanding the relationship between vitamin D 3 , arterial calcification, and lower extremity ischemia may help to improve outcomes in patients with PAD.

Attained Functional Status Moderates Survival Outcomes of Return to Work After Lung Transplantation.

Returning to work is a desirable outcome of lung transplantation that is selective on attained functional status. Survival implications of post-transplant employment are unclear. The United Network for Organ Sharing registry was queried for first-time lung transplants performed from May 2005 to March 2015 in patients ages 18-64. Attainment of normal functional status post-transplant, defined as a 100% score on the Karnofsky Performance Scale (KPS), was examined as moderating 5-year survival outcomes of work resumption, using Cox proportional hazards models. Supplemental analysis examined attainment of forced expiratory volume in 1s (FEV1) ≥80% predicted as moderating survival implications of post-transplant employment. Of 10,066 patients, 1824 (18%) returned to work, while 9078 contributed follow-up data on functional status. Multivariable analysis demonstrated a protective effect of work resumption among patients who did not attain normal functional status before returning to work (HR=0.62; 95% CI=0.51, 0.76; p<0.001). This association was attenuated among transplant recipients who reached 100% KPS while still unemployed (p<0.001). Similarly, post-transplant survival was favorably associated with 5-year survival among patients who did not attain at least 80% predicted FEV1 before returning to work (HR=0.71; 95% CI=0.59, 0.86; p<0.001). Early return to work after lung transplantation may benefit patients experiencing mild functional limitations. Timing the resumption of employment to coincide with attainment of maximal functional status around 1year post transplant should be considered.

Functional and structural abnormalities of the kidney and urinary tract in severely malnourished children - A hospital based study.

Objectives:The association of malnutrition and systemic diseases like chronic kidney disease (CKD) is well known. Various urinary tract abnormalities may be associated with malnutrition. So objective of current study was to determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children admitted in Nutritional Rehabilitation Unit (NRU) of a tertiary care facility, Karachi.Methods:This descriptive cases series of 78 children was conducted in NRU from October 2014 - March 2015. All newly admitted children aged 2-60 months, diagnosed as Severe Acute Malnutrition (SAM) were studied and children with known kidney and urinary tract disorders were excluded. Detailed history, examination and investigations like serum creatinine, ultrasound kidney and urinary tract in addition to routine tests for SAM, were done. A proforma was used to collect demographic data, clinical history, physical findings, and radio-imaging and biochemical investigations. Glomerular filtration rate (GFR) was calculated using Schwartz equation. Data was analyzed using descriptive statistics.Results:Among 78 children, male to female ratio was equal. Mean age was 18±15.53 months and majority (79.48%) of children were below 24 months. Majority (82%) of children with SAM had marasmus whereas 18% had edematous malnutrition. Out of 78, 57 (73%) children had either functional (80.7%) and or structural (19.3%) abnormalities whereas 21(36.84%) had normal functional and structural status. Most common functional abnormality was subnormal GFR (<90ml/min/1.73 m2) found in all 46 children. Functional abnormities were more common in children below 24 months. Other functional disorders were Bartter syndrome, renal tubular acidosis and urinary tract infection (UTI) found in two cases each. Common structural abnormalities were echogenic kidneys (n=4, 36%), hydronephrosis (n=3, 27%), hypoplastic kidneys (n=3, 27%) and calculi (n=1, 9%). Subnormal GFR was also found in all cases with structural abnormalities. UTI was observed exclusively in two children among 11 with structural abnormalities.Conclusion:A high frequency of functional abnormalities and noticeable proportion of structural abnormalities of urinary tract were detected in children with SAM. Current finding suggest that multicenter study at national level may be undertaken to generate better data about prevalence of renal diseases in SAM.