Device Removal Research Articles

A Case of Autoimmune progesterone dermatitis post-intrauterine device placement in rural occupied Palestine

Autoimmune progesterone dermatitis is considered a rare cyclical autoimmune reaction to endogenous progesterone in fertile females that is characterized by skin lesions ranging from mild urticaria to anaphylaxis. A 30-year-old woman who had an intrauterine device placed, presented to her family medicine clinic with erythema and some edematous lesions, and pruritus. The skin biopsy showed perivascular infiltrate with neutrophils and was diagnosed as autoimmune progesterone dermatitis. Treatment included intrauterine device removal and treatment with tamoxifen. This is the first documented case of autoimmune progesterone dermatitis in occupied Palestine.

Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.

Endovascular treatment of post-thrombotic syndrome of the lower extremities caused by combat trauma. Clinical case

In the course of Russia’s military invasion of Ukraine, gunshot shrapnel wounds of the lower extremities that result in damage to major blood vessels have become a common phenomenon. Their incidence is consistent with the general data on combat‑related vascular injuries. Vascular gunshot injuries can cause significant changes to the normal anatomy and hemodynamics of the extremity as a result of the bullet or shrapnel travelling through the wound channel. Combat trauma of the vascular bundle, either as a primary factor or in combination with other lesions, often causes a serious condition in the wounded that requires urgent surgical intervention]. Injury to the major blood vessels of the lower limbs carries the risk of critical ischemia, which can lead to higher mortality rates, poor limb recovery, and disability. This clinical case demonstrates the endovascular management of a disabling combat‑related vascular injury. The treatment involves the use of modern imaging techniques and minimally invasive surgical procedures. This case highlights the progression of the pathological process after a gunshot shrapnel wound to the soft tissues and major blood vessels. It also shows a change in the normal anatomy of the major blood vessels and the subsequent development of regional hemodynamic disorders of the lower limb after injury. In January 2023, a 51‑year‑old male received a gunshot wound to the soft tissues of the pelvis and right lower limb, as well as a gunshot fracture of the right femur. Immediate post‑evacuation therapy included the management of life‑threatening bleeding by ligating the deep femoral artery and providing external fixation of the gunshot femur fracture. Following the healing of the wounds and the removal of the external fixation device, the injured individual experienced a progressive and notable swelling of the lower limb over a period of 3 months. Subsequently, trophic ulcers appeared on the lower leg. In September 2023, the patient was admitted to the National Military Medical Clinical Centre in Kyiv after developing clinical signs of the post‑thrombotic syndrome. However, further examination revealed the presence of an AV fistula. Consequently, a simultaneous endovascular reconstructive intervention was performed on the arteries and veins of the patient’s lower extremity. Conclusions. A gunshot wound to the major blood vessels can contribute to pathological changes in the normal anatomical structure, resulting in arterial collateral blood circulation or narrowing of blood vessels that can lead to regional hemodynamic disorders. The clinical case exemplifies the importance of using modern imaging techniques for a comprehensive examination of the vascular system and the possibility of minimally invasive treatment for patients with gunshot injuries to the major blood vessels.

Atrial septal defect occluder devices and embolization – a case series

Introduction: Atrial Septal Defect (ASD) secundum is a commonly occurring congenital heart disease. Patients with unstable hemodynamic may require closure, which can be accomplished either percutaneous transcatheter of an atrial septal occluder (ASO) device or open surgery. Closure using an occluder carries the risk of device embolization (DE). Case Presentation: This case series presents two patients who had dislodgement after ASD closure using ASO. The demographic data, comorbidities, surgical details, and follow-up results are all summarized. A 9-year-old girl and a 12-year-old boy admitted to our centre. The girl echocardiography evaluation revealed dislodgment of ASD occluder in a large secundum ASD, right upper PV blockage, and a high chance of pulmonary hypertension (PH). While the boy showed the occluder device that was misplaced and positioned in the right ventricle. A secundum ASD with a left to right shunt and moderate TR with a peak pressure gradient of 21.5mmHg were also found. During the procedure, we discovered that the girl had an occluder in the superior rim of ASD II 3x2 cm, which was dislodged towards the lower right PV, above the mitral valve, and the posterior occluder leaflet was removed by replacing a section of the rim. We discovered a secundum ASD with a dimension of 2x1cm on the boy The occluder was found behind the anterior cusp of the tricuspid valve. The retrieved occluder device appeared intact, and the tricuspid valve was injured, but no rupture. Conclusion: The occurrence of ASO migration is uncommon, necessitating further surgery for device removal, closure of the remaining defect, and ensure there is no cardiac erosion or rupture. Surgery can also alleviate symptoms including shortness of breath and palpitations

Risk Stratification of QTc Prolongation in Critically Ill Patients Receiving Antipsychotics for the Management of Delirium Symptoms.

Patients experiencing significant agitation or perceptual disturbances related to delirium in an intensive care setting may benefit from short-term treatment with an antipsychotic medication. Some antipsychotic medications may prolong the QTc interval, which increases the risk of potentially fatal ventricular arrhythmias. In this targeted review, we describe the evidence regarding the relationships between antipsychotic medications and QTc prolongation and practical methods for monitoring the QTc interval and mitigating arrhythmia risk. Searches of PubMed and Cochrane Library were performed to identify studies, published before February 2023, investigating the relationships between antipsychotic medications and QTc prolongation or arrhythmias. Most antipsychotic medications commonly used for the management of delirium symptoms (eg, intravenous haloperidol, olanzapine, quetiapine) cause a moderate degree of QTc prolongation. Among other antipsychotics, those most likely to cause QTc prolongation are iloperidone and ziprasidone, while aripiprazole and lurasidone appear to have minimal risk for QTc prolongation. Genetic vulnerabilities, female sex, older age, pre-existing cardiovascular disease, electrolyte abnormalities, and non-psychiatric medications also increase the risk of QTc prolongation. For individuals at risk of QTc prolongation, it is essential to measure the QTc interval accurately and consistently and consider medication adjustments if needed. Antipsychotic medications are one of many risk factors for QTc prolongation. When managing agitation related to delirium, it is imperative to assess an individual patient's risk for QTc prolongation and to choose a medication and monitoring strategy commensurate to the risks. In intensive care settings, we recommend regular ECG monitoring, using a linear regression formula to correct for heart rate. If substantial QTc prolongation (eg, QTc > 500 msec) is present, a change in pharmacologic treatment can be considered, though a particular medication may still be warranted if the risks of discontinuation (eg, extreme agitation, removal of invasive monitoring devices) outweigh the risks of arrhythmias. This review aims to summarize the current literature on relationships between antipsychotic medications and QTc prolongation and to make practical clinical recommendations towards the approach of antipsychotic medication use for the management of delirium-related agitation and perceptual disturbances in intensive care settings.

The role of hospital-based vascular access teams and implications for patient safety: A multi-methods study.

Peripherally inserted central catheters (PICCs) and midline catheters are often placed by nurse-led vascular access teams (VATs). While some data regarding the effectiveness of these teams exists, less is known about their structure and function. To examine the roles, functions, and composition of VATs related to the use and management of PICC and midline catheters. A descriptive, multi-method study that included an online survey of 62 hospitals participating in a quality improvement consortium and qualitative interviews with 74 hospital-based clinicians in 10 sites. Interviews were recorded, transcribed, and analyzed using a rapid analysis and matrix approach. The survey, which contained closed-ended, categorical questions, was analyzed using frequencies and percentages. More than 77% (n = 48) of hospitals had an on-site VAT. The average team size was seven nurses; their primary function was device insertion. Interview findings revealed that teams varied in characteristics and functions. Interviewees described the broad role that teams play in device insertion, care and removal, and in educating/training hospital staff. However, we found that teams' role in decision making, particularly related to appropriate device selection, was limited and, in some cases, met with physician resistance. To realize the full benefit of VATs, changes in hospital culture, along with an increased willingness from physicians to integrate VAT nurses in decision making, may be needed. Future interventions aimed at engaging and empowering teams appear necessary.

Torque changes of anchorage units in preadolescent patients treated with a digitally designed tooth-borne expander anchored to deciduous vs. permanent molars.

To compare the effects on permanent or deciduous anchorage dental units in patients treated with a digitally designed palatal expander. Inclusion criteria were the following: presence of maxillary transverse deficiency, no previous orthodontic treatment, no extractions, absence of agenesis, congenital pathologies and cranio-maxillofacial malformations. Twenty patients (11 males, 9 females, 11 ± 1.8 years) received a digitally designed and metal printed palatal expander anchored on first permanent molars and 1 activation per day for 30 days (Group 1). Twenty-one patients (12 males, 9 females, 8.6 ± 1.4 years) received a digitally designed and metal printed palatal expander anchored on second deciduous molars and 2 activations per day for 14 days (Group 2). Digital intraoral scans were taken before expansion and after device removal, and torque and the palatal transverse diameter were digitally measured. The FDI notation was used to indicate each tooth CONCLUSION: Less dental torque augmentation was produced in Group 2. Significant intragroup differences over time were found in Group 1 considering the torque of teeth 1.6, 1.4, 1.3, 2.1, 2.4, 2.5, 2.6. Significant differences between groups were found regarding the longitudinal change in torque of teeth 1.5, 2.4 and 2.5. Significant intragroup differences over time were found in both groups considering all transverse diameter parameters. No significant differences were found between groups in the transverse diameter modifications over time. Less dental torque augmentation was produced in Group 2.

Safety and Efficacy of 12-Month Intra-gastric Balloon-Series of over 1100 Patients.

Intra-gastric balloons (IGB) are a mainstay of endoscopic treatment of overweight and obesity. In recent years, an IGB which can remain in situ for 12 months has been developed. The current study aimed to analyse the safety and efficacy of this 12-month IGB. Consecutive patients receiving the Orbera 365TM IGB (Apollo Endosurgery, TX, USA) between September 2017 and August 2021 were included in a prospective database. Patients received regular follow-up consultations followed by endoscopic removal at 12 months. Demographic data along with weight loss data were collected. All adverse events were recorded. In total, 1149 patients were included in the study. A majority of the patients were female (87.13%). Median body mass index (BMI) prior to insertion was 36.30 kg/m2 (IQR 32.60-40.00 kg/m2). Median absolute weight loss for all patients was 11.36 kg (IQR 6.70-16.82 kg). There was ongoing sustained weight loss until device removal at week 52. For patients with a weight recording at point of IGB removal, median weight loss was greater (15.88 kg, IQR 10.43-21.72) with percentage total body weight loss of 15.38% (IQR 10.99-21.77) and excess weight loss of 53.99% (IQR 32.44-76.30). Increased patient engagement with post-procedural follow-up was associated with increased weight loss (p<0.001). There were 60 total complications (5.22%). Fifty patients required balloon removal due to intolerance. There were eight cases of balloon rupture. There were only two severe complications (0.17%). The current study has confirmed safety of this IGB at 12 months with adverse events comparable to published literature. Weight loss increased up until the point of removal at 12 months.

Coptisine Down-Regulates Soluble Intercellular Adhesion Molecule-1 by Inactivating Fas/FasL Signaling Pathway to Inhibit the Recurrence After Orthodontics

In this study, by constructing a rat model of orthodontic recurrence and intervening with coptisine, the IL-6, IL-8, TNF-α and soluble intercellular adhesion molecule-1 (sICAM-1) content were analyzed to assess the regulatory mechanism of coptisine on the health status of recurrent periodontal tissue after orthodontics and the occurrence of periodontal tissue inflammation. Male rats were assigned into three groups by constructing coptisine liposome nano-objects: blank group (Blank, 10 rats), orthodontic tooth movement model group (50 rats). The orthodontic tooth movement model group was randomly divided into model group (module), model control group (control-free), model coptisine treatment group (treatment-free), model blank functional liposome group (control-lip) and model functional coptisine liposome group (treatment-lip). Rats in model group were killed on the day after device was removed. Rats in other groups received equal doses of normal saline, coptisine, blank functional liposomes, and functional coptisine liposomes by intragastric administration on the day of device removal and then were killed after 7 days of continuous treatment. Through Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, we found that Fas/FasL signaling pathway was enriched in pathways related to apoptosis, disease infection and inflammation. Western blot experiments confirmed that coptisine could inhibit Fas/FasL signaling activation in the process of relapse after orthodontics. Lipopolysaccharides (LPS) treatment significantly increased inflammatory cytokines and sICAM-1, as well as the level of Fas and FasL. Coptisine treatment inhibited LPS-induced Fas/FasL signaling pathway in periodontal ligament cells. Coptisine attenuated the relapsed inflammation after orthodontics by inhibiting Fas/FasL signaling.

Clip Dislodgement After Full-Thickness Endoscopic Resection Device Removal of Scarred Gastric Subepithelial Lesion Leading to Delayed Perforation

ABSTRACT Endoscopic full-thickness resection using a full-thickness resection device is a newer technique for endoscopic removal of submucosal lesions not amenable to endoscopic mucosal resection or endoscopic submucosal dissection. There is a low rate of complications reported, although we report 2 cases of delayed perforation caused by dislodgement of a full-thickness resection device clip after removal of scarred gastric lesions. Both were managed endoscopically with good outcomes. However, special attention and consideration of alternative closure techniques should be considered with scarred gastric lesions and possible changes to the clip design could be considered.

2408. Is Shorter Antibiotic Treatment Feasible in Patients with Cardiac Implantable Electronic Devices (CIED) Infections? Impact of Treatment Duration on 6-Month Recurrence and Mortality

Abstract Background Aim of this study is to compare the 6-month outcomes (recurrence and mortality) of patients with cardiac implantable electronic device (CIED) infections treated with short (SHORT, &amp;lt;14 days) or long (LONG, &amp;gt;14 days) duration of antimicrobial therapy after device removal. Methods Retrospective cohort study of patients hospitalized at IRCCS San Raffaele Hospital (Milan, Italy) from June 2011 to June 2021, who underwent device removal for CIED infection. Patients with pocket and lead infections were included, while valve endocarditis and Staphylococcus aureus infection were excluded. The characteristics of patients in the SHORT and LONG groups were compared using the chi-square test for categorical variables and the Mann-Whitney U-test for continuous variables. A propensity score (PS) was calculated using a logistic regression that considered duration of therapy as the dependent variable; the association between patients’ characteristics and outcomes was evaluated with logistic regression analysis. Results The characteristics of the 150 included patients are described in table 1, the microbial etiology in table 2. Patients in the SHORT compared to the LONG group were older (75 [65-80] vs 69 [62-77], p-value=0.047), had a higher Charlson comorbidity index (5 [3-6] vs 4 [3-5], p-value=0.021), had less frequent isolation of coagulase-negative staphylococci (CoNS; 46.7% vs 68.9%, p-value=0.006), and an unknown etiology (36.7% vs 13.3%, p-value=0.001). Moreover, the duration of antimicrobial treatment after device removal was shorter (13 [9-14] vs 20 [16-29] days, p-value&amp;lt; 0.001). At 6 months, recurrence and mortality were not significantly different between the SHORT and the LONG group (recurrences: 2 [3.7%] vs 5 [6.7%], p-value=0.464; mortality: 2 [3.7%] vs 3 [4.0%], p-value=0.931), At logistic regression analysis (table 3 and table 4) adjusted for PS, treatment duration was not significantly associated with either recurrence (odds ratio [OR] 0.524; 95% confidence interval [95%CI] 0.084-3.263) or mortality (OR 1.402; 95%CI 0.185-10.635). Conclusion A shorter duration of antimicrobial treatment after device removal may be an effective approach for treating patients with CIED infections. Disclosures Antonella Castagna, MD, Bristol-Myers Squibb: consultancy payments and speaking fees|Gilead: consultancy payments and speaking fees|Janssen-Cilag: consultancy payments and speaking fees|Merck Sharp &amp; Dohme: consultancy payments and speaking fees|ViiV Healthcare: consultancy payments and speaking fees

2401. The Role of Quantitative Microbial Cell-free DNA (mcfDNA) Sequencing (Seq) from Plasma in the Diagnosis (Dx) of Staphylococcal Cardiac Implantable Electronic Device Infective Endocarditis (CIED IE)

Abstract Background Optimal treatment (rx) of staphylococcal CIED IE requires removing the entire CIED. Difficulty of dx plus cost and potential morbidity of rx make treatment challenging. Complicated staphylococcal bacteremia is associated with prolonged detection of plasma mcfDNA during antibiotic rx. To assess for IE, we studied plasma mcfDNA kinetics in CIED patients (pts) with staphylococcal bacteremia undergoing CIED removal. Methods With written consent, CIED pts (no persistent confounding infection) with bacteremia in the prior ≤ 7 days (d) and planned CIED removal had serial plasma specimens collected [Figure]. Quantitative mcfDNA-Seq was done using the Karius Test® at Karius CLIA certified Laboratory (Redwood City,CA) on batched pt specimens. Clinical data were obtained from the electronic medical record. CIEDs were removed through sterile pockets or surgically except in pt 012. Definite CIED IE was defined by multiple d of bacteremia plus a definite lead / tricuspid vegetation per echocardiogram, direct inspection or lead tip culture; multiple d bacteremia or a definite vegetation defined possible CIED IE. Results Nine pts with definite CIED IE had bacteremia 3-13 d (median 6 d) with Staphylococcus aureus (7 pts) or S. epidermidis (2 pts: 012 who due to retained lead fragment relapsed after rx 021) [Table 1]. At consent, after 2-11 d rx (median 6 d) mcfDNA was detected in 8 of 9 pts; in all 9, on CIED extraction mcfDNA increased significantly from consent and pre-extraction levels [Table3]. Five pts with possible S.aureus CIED IE had 1-3 d (median1 d) bacteremia [Table 2]. None had plasma mcfDNA after 5 d rx and 4 of 5 had no mcfDNA detectable on device extraction [Table3]. McfDNA patterns in definite CIED IE (8 of 9 pos on consent / pre-extraction and had an increase on extraction) differed from those in possible CIED IE (4 of 5 neg at 5 d of rx and none detected on extraction) [p=0.023 Fisher Exact]. Conclusion Quantitative mcfDNA patterns can help distinguish definite from possible CIED IE and absence of mcfDNA in plasma of possible CIED IE on device extraction suggests that the CIED may not be infected. After 5 days of rx, plasma mcfDNA-Seq in CIED pts with staphylococcal bacteremia coupled with clinical features may identify patients that can be effectively treated without device removal - a testable hypothesis. Disclosures Adolf W. Karchmer, MD, DeBiopharma: Advisor/Consultant|DeBiopharma: Honoraria|Karius: Grant to Institution for this study Jason D. Matos, MD, Merck: Wife is an employee Nicholas R. Degner, MD, MPH, MS, Karius: Employer

2438. Positive Cerebrospinal Fluid Cultures from Intraventricular Reservoirs for CLN2 Patients: One Institution's Experience

Abstract Background Enzyme replacement therapy (ERT) with cerliponase alfa (Brineura) has been shown to slow progression of milestone deterioration in Neuronal Ceroid Lipofuscinosis Type 2 (CLN2), an inherited neurodegenerative lysosomal storage disorder. Brineura must be administered intraventricularly every 2 weeks, necessitating the placement of ventricular reservoirs and requiring frequent access. Traditionally, positive cerebrospinal fluid (CSF) cultures are managed with device replacement and antibiotic treatment. We sought to establish which circumstances might allow for careful observation without device removal. In this study, we report our single-institution experience with clinical outcomes of positive CSF cultures in 16 CLN2 patients over 6 years. Methods We retrospectively reviewed a cohort of 16 patients with CLN2 disease who had ventricular reservoirs placed for ERT administration. At each ERT infusion, CSF was collected by sterile technique and cultured by both thioglycolate broth and agar plate. Epidemiologic and microbiologic data, symptomatology, total antibiotic days, removal and replacement of ventricular reservoir, hospital length of stay, and mortality were analyzed for each patient. Results In our cohort, 11 of 16 patients (69%) had at least one positive CSF culture (Fig 1). Of the 11 with positive cultures, only 3 had their device removed and replaced for a positive culture with concurrent antibiotic treatment at our center, and 2 patients subsequently have been treated with prophylactic antibiotics at infusions (Fig 2). Out of 1401 total CSF cultures, 64 (4.56%) were positive. The most common organism grown was Cutibacterium acnes, which typically grew in only broth culture (82%), suggesting low bacterial burden (Fig 3). The other 7 patients with positive cultures remained asymptomatic with no intervention required. Conclusion At our institution, we have found that in asymptomatic patients with frequently accessed ventricular reservoirs, positive CSF culture with low virulence skin flora was common, and rarely required intervention. This strategy reduced the risks of invasive surgery, prolonged antibiotic courses, and missed infusions. In the future, routine screening cultures in asymptomatic patients can be avoided. Disclosures Raymond Wang, MD, Biomarin Pharmaceutical: Advisor/Consultant|Biomarin Pharmaceutical: Grant/Research Support|Biomarin Pharmaceutical: equity interest Antonio C. Arrieta, MD, FIDSA, FPIDS, Astellas Pharma Global Development, Inc.: Advisor/Consultant|Astellas Pharma Global Development, Inc.: Grant/Research Support|Astellas Pharma Global Development, Inc.: Honoraria|Cumberland Pharmaceutical: Grant/Research Support|IDbyDNA: Advisor/Consultant|IDbyDNA: Grant/Research Support|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Nabriva: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Pfizer, Inc: Advisor/Consultant|Pfizer, Inc: Grant/Research Support|Roche/Genentech: Grant/Research Support|The Medicine Company: Grant/Research Support

Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal.

The use of Impella assist device for high-risk percutaneous coronary interventions and cardiogenic shock has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Herein, we describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. We performed a retrospective review of electronic medical records of patients who underwent LBA closure using this method from July 1, 2018 to June 30, 2022. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr catheters with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate/delayed bleeding, and access site complications were included. Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with this method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 ± 16 years. After downsizing of the femoral sheath to 6 Fr, 14 patients underwent manual compression, 3 patients had a 6 Fr catheter left in place to maintain access, and 3 patients underwent placement of a Perclose or Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. Five patients (25%) died inpatient; the deaths were unrelated to complications of Impella removal. In conclusion, LBA closure post-Impella removal with this novel method was safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.

Relationship between higher estrus-associated temperatures and the bovine preovulatory follicular fluid metabolome

IntroductionA higher estrus-associated temperature (HEAT) is a hallmark feature in sexually active females; however, its functional importance is unclear. Our objective was to examine the relationship between HEAT and the preovulatory follicular fluid metabolome. It was hypothesized that HEAT is functionally important as it affects fertility-related components in the preovulatory follicle.MethodsEstrus was synchronized in non-lactating Jersey cows. A Thermochron iButton temperature data logger was affixed to blank controlled internal drug release (CIDR) devices and intravaginally inserted after CIDR device removal. The follicular fluid was aspirated 14.9 h + 3.3 h after an animal first stood to be mounted. Regression models were performed using metabolite abundance and HEAT variables. Best-fit models were determined using backward manual selection (p &amp;lt; 0.05).ResultsA total of 86 metabolites were identified in cow follicular fluid samples. The vaginal temperature at first mount and when it was expressed as a change from baseline was positively related to the abundance of four metabolites (i.e., taurine, sn-glycerol 3-phosphate, glycine, and cysteine) and negatively related to one metabolite (i.e., serine). The vaginal temperature at the first standing mount was related to the differential abundance of two metabolites (i.e., jasmonate and N-carbamoyl-L-aspartate). Three metabolites were related to the maximum vaginal temperature (i.e., N-carbamoyl-L-aspartate, uracil, and glycodeoxycholate). When expressed as a change from baseline, the maximum vaginal temperature was related to the differential abundances of uracil, uric acid, and 6-phospho-D-gluconate. The time taken to reach maximum vaginal temperature was related to N-carbamoyl-L-aspartate, glycodeoxycholate, jasmonate, and tricarballylic acid. Pertaining to the combination of HEAT and its duration, the area under the curve associated with the time between the first increase in vaginal temperature and the maximum vaginal temperature was related to 6-phospho-D-gluconate, sulfolactate, guanidoacetic acid, and aspartate. The area under the curve associated with the time between the initial vaginal temperature increase and up to 10 h after a cow first stood to be mounted or when a cow’s temperature returned to baseline was related to the differential abundances of uracil, sn-glycerol 3-phosphate, methionine sulfoxide, and taurodeoxycholate.DiscussionOur findings support the notion that HEAT is related to changes in the preovulatory follicular fluid metabolites involved in energy metabolism, thermoregulation, and oxidative stress management.

Abstract 13561: Hospital Outcomes of Chronic Kidney Disease Patients After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Devices

Background: Chronic kidney disease (CKD) is a common comorbidity among patients who require transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED). However, its impact on the outcomes of this procedure remains unclear. Objective: This study aimed to investigate the impact of CKD and end-stage renal disease (ESRD) on the outcomes following TLR of infected CIED. Method: Using the Nationwide Readmissions Database, we identified and analyzed the hospital outcomes of patients aged ≥18 years, who underwent TLR of infected CIED from 2017 to 2020. The patient cohort was further stratified by the presence of CKD diagnoses. Survey-based weighted univariable and multivariable analyses were performed to investigate whether CKD of different stages independently predicts worse outcomes among these patients. Results: A total of 10,928 patients who underwent TLR of infected CIED were included in our study. Amongst, 3,794 (34.7%) patients had CKD not requiring dialysis, and 605 (5.5%) patients had ESRD on dialysis. The patients with ESRD on dialysis had the highest rates of early mortality (10.6% vs 7.7% vs 4.1%, p&lt;0.01), non-home discharge (46.1% vs 43.3% vs 30.5%, p&lt;0.01), prolonged hospitals stay (90.6% vs 84.9% vs 72.6%, p&lt;0.01), and 30-day readmission (25.5% vs 24.6% vs 17.1%, p&lt;0.01) compared to CKD not requiring dialysis patients and non-CKD patients. Via multivariable analyses, the risk of poorer in-hospital outcomes increased with the severity of CKD. Apart from cardiac arrest, CKD was not significantly associated with increased procedural complications following the TLR procedure. Conclusion: Chronic kidney disease, particularly ESRD was associated with poorer hospital outcomes following TLR of infected CIED. The procedural complications were not significantly increased in CKD patients, except for cardiac arrest. These highlight the importance of meticulous peri-procedural management in CKD patients.

Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors

Introduction: Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited. Methods: We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management. Results: The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy. The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction. Conclusion: We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.

Abstract 14956: Outcomes of Leadless Pacemaker Implantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device: A Systematic Review

Background: The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED) are not well-established. Objective: This study sought to describe the outcomes of LP implantation following TLR of infected CIED. Method: We conducted a literature search using PubMed and Embase for a combination of term including leadless pacemaker implantation, transvenous lead extraction, transvenous lead removal , transvenous lead explant , infected cardiac implantable electronic device . The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for non-infectious reason. Study end-points were procedural complications and LP infection. Result: Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 69% males) were included. Amongst, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus Aureus was the most common causative organism in 33% of the reported patients. Of 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during TLR procedure, and 36 patients (14.2%) had transvenous pacing as a bridge from TLR to LP implantation. During the LP implantation, 1 patient (0.4%) had an intra-procedural complication requiring sternotomy. Post-LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. Conclusion: This study suggests that LP implant is feasible and safe post-removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%.

COMPARISON OF CONTINUATION OF POST-PLACENTAL INSERTION OF COPPER T AFTER CESAREAN SECTION AND NORMAL VAGINAL DELIVERY

Objective: The objective of this study was to assess the efficacy of post-placental copper T insertion following vaginal and cesarean delivery. Methods: This is a prospective study conducted for the period of 1 year on pregnant females undergoing deliveries at Department of Obstetrics and Gynecology, Sardar Patel Medical College and AGH, Bikaner. The total number of postpartum intrauterine contraceptive device inserted participants included in the study were 200, divided into two groups vaginal (group A) and lower segment cesarean section (LSCS) (group B) groups. Results: Mean age of the patients was 26.15±4.02 years. Most of the acceptors in both the groups were para-2 with 30% in vaginal group and 76% in LSCS group. The complaints at 6 weeks follow-up, in both groups, were similar, but the rate of removal was higher in vaginal group (9%) compared to LSCS group (2%). At 3 months follow-up, in vaginal group, the most common complaint was bleeding per vagina (PV) in 7.31% cases whereas missing thread 31.25% in LSCS group. Over a period of 3 months, the main reason for intrauterine contraceptive devices (IUCD) removal was bleeding PV in both group (six cases in vaginal group and three cases in LSCS group). Conclusion: Immediate post-partum insertion of IUCD appears to be safe and effective method of contraception.

Safety profile of magnetic sphincter augmentation for gastroesophageal reflux disease.

The magnetic sphincter augmentation (MSA) procedure is an effective treatment for gastroesophageal reflux disease (GERD). Adverse events requiring MSA device removal are rare, but the true prevalence and incidence may be underestimated. Retrospective study on a prospectively collected database. Patients who underwent MSA procedure between March 2007 and September 2021 in two tertiary-care referral centers for esophageal surgery were included. The trend of MSA explant, the changes in the sizing technique and crura repair over the years, the technique of explant, and the clinical outcomes of the revisional procedure were reviewed. Out of 397 consecutive patients, 50 (12.4%) underwent MSA removal, with a median time to explant of 39.5 [IQR = 53.7] months. Main symptoms leading to removal were dysphagia (43.2%), heartburn (25%), and epigastric pain (13.6%). Erosion occurred in 2.5% of patients. Smaller (12- and 13-bead) devices were the ones most frequently explanted. The majority of the explants were performed laparoscopically with endoscopic assistance. There was no perioperative morbidity, and the median length of stay was 2.8 ± 1.4 days. After 2014, changes in sizing technique and crura repair resulted in a decreased incidence of explants from 23% to 5% (p < 0.0001). Multivariate analysis confirmed the protective role of added bead units [HR 0.06 (95% CI = 0.001-0.220); p < 0.000]. Oversizing and full mediastinal dissection with posterior hiatoplasty may improve the outcomes of the MSA procedure and possibly reduce removal rates.