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Background: Care of pediatric heart transplant recipients relies upon serial invasive hemodynamic evaluation, generally performed under the artificial conditions created by anesthesia and supportive ventilation. Objectives: This study aimed to evaluate the hemodynamic impacts of different anesthetic and ventilatory strategies. Methods: We compared retrospectively the cardiac index, right- and left-sided filling pressures, and pulmonary and systemic vascular resistances of all clinically well and rejection-free heart transplant recipients catheterized from 2005 through 2017. Effects of spontaneous versus positive pressure ventilation and of sedation versus general anesthesia were tested with generalized linear mixed models for repeated measures using robust sandwich estimators of the covariance matrices. Least squared means showed adjusted mean outcome values, controlled for appropriate confounders. Results: 720 catheterizations from 101 recipients met inclusion criteria. Adjusted cardiac index was 3.14 L/min/m2 (95% CI 3.01–3.67) among spontaneously breathing and 2.71 L/min/m2 (95% CI 2.56–2.86) among ventilated recipients (p < 0.0001). With spontaneous breathing, left filling pressures were lower (9.9 vs 11.0 mmHg, p = 0.030) and systemic vascular resistances were higher (24.0 vs 20.5 Woods units, p < 0.0001). After isolating sedated from anesthetized spontaneously breathing patients, the observed differences in filling pressures and resistances emerged as a function of sedation versus general anesthesia rather than of spontaneous versus positive pressure ventilation. Conclusion: In pediatric heart transplant recipients, positive pressure ventilation reduces cardiac output but does not alter filling pressures or vascular resistances. Moderate sedation yields lower left filling pressures and higher systemic vascular resistances than does general anesthesia. Differences are quantitatively small. [ABSTRACT FROM AUTHOR]

The article presents a study on whether the use of the central venous catheter (CVC) nonwire hub as a source of blood cultures decreased contamination while maintaining detection of true pathogens. The study involved 313 blood cultures from 227 CVCs in 139 patients. A higher contamination rate was found in guidewire compared to nonwire hub cultures, while detection of true pathogens was equivalent. It suggests that cultures from CVC insertion should be taken from the nonwire hub.

Abstract: We examined the effect of APOC1-317insCGTT allele status (HpaI RFLP, deletion [H1] and insertion [H2] alleles) on serum apolipoprotein (apo) C-I level in 362 Hispanic children in the Columbia University BioMarkers Study. The H2 allele was present in 147 subjects (40.6%). Serum apoC-I was 20% lower in the presence of the H2 allele in APOE ɛ3/ɛ3 homozygotes (P =0.003) but did not differ by H2 status in ɛ4 carriers. Insufficient numbers of ɛ2 carriers (N =45) were present for analysis. In multivariate analysis in the ɛ3/ɛ3 context, after adjusting for potential covariate effects and familial aggregation, the mean effect of H2/* versus H1/H1 on apoC-I level, was estimated to be 2.15±0.55mg/dl (P &#60;0.0025). Plasma triglyceride level was weakly correlated with serum apoC-I level (Pearson''s r =0.17, P &#60;0.001) but was highly correlated with serum apoC-III (Pearson''s r =0.74, P &#60;0.0001). Nevertheless, presence of the H2 allele was not significantly associated with serum apoC-III level. Thus, the effect of APOC1 genotype on serum apoC-I level was not due to apoC-I level serving as a surrogate for triglyceride level. The APOC1-317insCGTT allele is a commonly polymorphic genetic marker that is associated with serum apoC-I level in the APOE ɛ3/ɛ3 context. These findings suggest that the mechanism of the previously described association with plasma TG is, at least in part, related to the correlation of the polymorphism with the level of expression of apoC-I. [Copyright &y& Elsevier]