Impact of hospital transfer on surgical outcomes of intestinal atresia.

BACKGROUND: Examine effects of hospital transfer into a quaternary care center on surgical outcomes of intestinal atresia. METHODS: Children <1 yo principally diagnosed with intestinal atresia were identified using the Kids' Inpatient Database (2012). Exposure variable was patient transfer status. Outcomes measured were inpatient mortality, hospital length of stay (LOS) and discharge status. Linearized standard errors, design-based F tests, and multivariable logistic regression were performed. RESULTS: 1672 weighted discharges represented a national cohort. The highest income group and those with private insurance had significantly lower odds of transfer (OR:0.53 and 0.74, p < 0.05). Rural patients had significantly higher transfer rates (OR: 2.73, p < 0.05). Multivariate analysis revealed no difference in mortality (OR:0.71, p = 0.464) or non-home discharge (OR: 0.79, p = 0.166), but showed prolonged LOS (OR:1.79, p < 0.05) amongst transferred patients. CONCLUSIONS: Significant differences in hospital LOS and treatment access reveal a potential healthcare gap. Post-acute care resources should be improved for transferred patients.

A scientist's guide for submitting data to ZFIN.

The Zebrafish Model Organism Database (ZFIN; zfin.org) serves as the central repository for genetic and genomic data produced using zebrafish (Danio rerio). Data in ZFIN are either manually curated from peer-reviewed publications or submitted directly to ZFIN from various data repositories. Data types currently supported include mutants, transgenic lines, DNA constructs, gene expression, phenotypes, antibodies, morpholinos, TALENs, CRISPRs, disease models, movies, and images. The rapidly changing methods of genomic science have increased the production of data that cannot readily be represented in standard journal publications. These large data sets require web-based presentation. As the central repository for zebrafish research data, it has become increasingly important for ZFIN to provide the zebrafish research community with support for their data sets and guidance on what is required to submit these data to ZFIN. Regardless of their volume, all data that are submitted for inclusion in ZFIN must include a minimum set of information that describes the data. The aim of this chapter is to identify data types that fit into the current ZFIN database and explain how to provide those data in the optimal format for integration. We identify the required and optional data elements, define jargon, and present tools and templates that can help with the acquisition and organization of data as they are being prepared for submission to ZFIN. This information will also appear in the ZFIN wiki, where it will be updated as our services evolve over time.

In-line microwave blood warming of in-date human packed red blood cells.

OBJECTIVE: To verify two hypotheses: a) In-line microwave warming of cold in-date packed red blood cells (RBCs) does not produce significant hemolysis; and b) in-line microwave warming achieves higher outlet temperatures as compared with current blood warming technology at high flow rates (> 250 mL/min). DESIGN: Multiple part, randomized, controlled study. SETTING: Surgical research laboratory of a large university medical center. SUBJECTS: Twenty-four units of cold, ready for transfusion in-date packed RBCs ranging in storage age from 6 to 16 days. INTERVENTIONS: Part I: Microwave apparatus outlet, warmed vs. unwarmed. Six units of cold packed RBCs was split into paired samples and infused at 13 mL/min through a 700-watt in-line microwave test apparatus. One paired specimen was warmed to 37 degrees C; the other was infused without warming (control). Blood was analyzed at the outlet. Part II: Microwave and countercurrent warming, inlet vs. outlet. Twelve units of cold packed RBCs was analyzed biochemically both before (inlet) and after (outlet) simulated transfusions. Six units was infused through a 900-watt in-line microwave test apparatus at > 500 mL/min. Six separate cold units were warmed at this rate using single channel countercurrent water bath warming. Part III: Microwave and countercurrent technology, inlet vs. outlet, warmed vs. unwarmed. a) Six units of cold packed RBCs was also analyzed biochemically and infused at 5 mL/min through either a microwave or countercurrent water bath warmer. b) Packed RBCs from the units used in part a) were allowed to remain stationary in the microwave heating cartridge for 15 mins with an activated heating element. Parallel stationary flow studies were done using the countercurrent blood warmer. Control unwarmed samples were also tested. MEASUREMENTS AND MAIN RESULTS: Part I: No statistical differences in hemolysis parameters were observed between microwave warmed and unwarmed packed RBCs. Part II: At high-flow rates, no statistical increases in hemolysis parameters were seen after in-line microwave or countercurrent water bath warming as compared with prewarmed cold controls. Part III: At slow-flow rates, nonstatistically significant increases were seen by passing the packed RBCs through either test apparatus unwarmed. Packed RBCs remaining stationary within microwave and countercurrent heating cartridges for 15 mins did show biochemical evidence of hemolysis. Mean plasma hemoglobin increased from 14 +/- 1.7 mg/dL in cold prewarmed units to 57.7 +/- 5.8 mg/dL (p < .05), when warmed in the microwave heating cartridge, and to 55.2 +/- 25 mg/dL (p < .05), when warmed in the countercurrent heat exchanger. Outlet Temperature Studies. Part II: The in-line 900-watt microwave device warmed cold units from a mean inlet temperature of 8.3 +/- 0.3 degrees C to a mean outlet temperature of 31.8 +/- 0.5 degrees C within 5 secs at a mean flow rate of 556 mL/min. At 30 secs, the mean outlet temperature was 33.9 +/- 0.4 degrees C (mean inlet temperature = 9.6 +/- 0.2 degrees C) for microwave warmed packed RBCs as compared with 32.1 +/- 0.5 degrees C (mean inlet temperature = 9.6 +/- 0.3 degrees C) in countercurrent water bath warmed blood (p < .05). From 20 to 30 secs, the packed RBCs warmed by microwave were statistically warmer than the countercurrent water bath warmed packed RBCs. CONCLUSIONS: a) Both in-line countercurrent warming and in-line microwave warming were associated with small increases in parameters of red cell damage representing statistically and clinically insignificant hemolysis. b) Blood sitting in any blood warming device is subject to statistically significant but clinically irrelevant increases in those parameters. c) At high-flow rates, the in-line microwave device warmed blood to higher outlet temperatures than the single channel countercurrent water bath warmer. This method may represent a clinical blood warming modality of the near future.

Glycosylated recombinant human tumor necrosis factor binding protein-1 reduces mortality, shock, and production of tumor necrosis factor in rabbit Escherichia coli sepsis.

OBJECTIVE: To examine the effect of glycosylated recombinant human tumor necrosis factor binding protein-1 (r-hTNF binding protein-1), the extracellular domain of the tumor necrosis factor receptor p55 produced in mammalian cells, in a rabbit model of circulatory shock due to Escherichia coli. DESIGN: Prospective, randomized, controlled trial. SETTING: University hospital research laboratory. SUBJECTS: Eighteen female, New Zealand white rabbits. INTERVENTIONS: Anesthetized rabbits, infused with E. coli (10(9) organisms/kg), were pretreated with either r-hTNF binding protein-1 or saline. Mean arterial pressure, central venous pressure, cardiac output, and heart rate were recorded every 20 mins for 1 hr before, and for 4 hrs after, the infusion of E. coli. Blood samples were obtained at 1-hr intervals for platelet count and white blood cell count, r-hTNF binding protein-1, and tumor necrosis factor (TNF) measurements. MEASUREMENTS AND MAIN RESULTS: Administration of r-hTNF binding protein-1 resulted in improvement of mean arterial pressure, cardiac output, and systemic vascular resistance, as compared with the vehicle-treated group (p < .05). Treatment with r-hTNF binding protein-1 was associated with 100% survival, as compared with 55.6% of the saline-treated rabbits (p < .05). Approximately 85% of r-hTNF binding protein-1 was cleared from the circulation 1 hr after the bolus injection (from 171 +/- 27 micrograms/mL at time = 0, to 27 +/- 4 micrograms/mL at 60 mins, decreasing to 6 +/- 2 micrograms/mL for the next 3 hrs). The r-hTNF binding protein-1-treated rabbits had lower serum TNF bioactivity during the first 2 hrs (p < .01). The decreased bioactivity of TNF was confirmed by a specific radioimmunoassay for rabbit TNF. However, at 4 hrs, the vehicle-treated rabbits had lower serum bioactive TNF concentrations (p < .05). The decrease in TNF concentrations in the r-hTNF binding protein-1-treated rabbits resulted from decreased production and, in part, from carry-over of r-hTNF binding protein-1 into the bioassay. CONCLUSIONS: Treatment with r-hTNF binding protein-1 improved hemodynamic variables and survival of E. coli-challenged rabbits. Administration of r-hTNF binding protein-1 suppressed bioactivity of TNF in the circulation of these rabbits, and the production of TNF as well.

Novel antiadhesion barrier does not prevent anastomotic healing in a rabbit model.

Intraperitoneal adhesions following surgical procedures cause considerable morbidity. Hyaluronic acid/carboxymethylcellulose (HA/CMC) films have been shown to be effective agents in decreasing adhesion formation. However, when there is an inadvertent leak of bowel contents into the peritoneum due to incomplete anastomosis, adhesion formation about a defect in order to prevent further leakage and to promote healing of the wound is important for the prevention of morbidity and mortality. The purpose of this study was to determine if an antiadhesion film (HA/CMC) impairs these potentially beneficial adhesions to bowel anastomoses, thus predisposing them to enteric leaks with subsequent peritonitis. Sixty-four rabbits were divided in two groups, each undergoing a complete or partial (90% anastomosis to simulate anastomotic leak) large bowel anastomosis. Half of each of the above groups were treated by wrapping a HA/CMC film over the anastomosis and the other half were untreated controls. These two subgroups were then further divided equally and sacrificed at either 7 or 14 days for evaluation of anastomosis integrity and strength. The average anastomotic bursting pressures did not change significantly between those groups treated with HA/CMC when compared to untreated controls at 7 or 14 days or in the complete or partial anastomosis group (Student's t test). Adhesion formation to the anastomosis was not impaired in either group independent of HA/CMC film application. This study suggests that while HA/CMC film has been shown to decrease adhesions in other models, healing of a rabbit colonic anastomosis even in the presence of an anastomotic defect takes place, further suggesting that the stimulus for adhesion formation can overcome the antiadhesion properties of HA/CMC.(ABSTRACT TRUNCATED AT 250 WORDS)