Search

Poultry are normally reared on bedding materials such as wood shavings or rice hulls. Poultry litter reuse for multiple flocks has become economically important in modern broiler production. However, this practice results in the litter serving as a reservoir of numerous microbial organisms, including, yeasts, molds, multiple types of viruses, and bacterial pathogens such as Salmonella, Escherichia, Campylobacter, Clostridium, Staphylococcus, and Pseudomonas. The foodborne pathogens are of particular importance for poultry producers. During the preharvest feed withdrawal period, consumption of contaminated litter and feces by the birds can lead to infection of the upper gastrointestinal tract with Salmonella, which presents substantial problems at processing. The current study was conducted to determine whether the use of a liquid bacterial product (LBP), such as LT1000, could reduce the load of Salmonella Typhimurium in poultry manure. The LBP was added to sterile poultry manure then challenged with 108 cfu/mL of Salmonella Typhimurium. The concentration of Salmonella Typhimurium was measured over 9 d or until the Salmonella Typhimurium was no longer detected. In 91% of the trials, Salmonella Typhimurium was completely eliminated within 9 d. This demonstrates that the LBP used in the current study has the potential to substantially improve the overall microbiological safety of used poultry litter. [ABSTRACT FROM PUBLISHER]

Information implicating bacterial biofilms as contributory factors in the development of environmental bacterial resistance has been increasing. There is a lack of information regarding the role of biofilms within the microbial ecology of the gastrointestinal tract of food animals. This work used a continuous-flow chemostat model derived from the ceca of 7-day-old chicks to characterize these communities and their ability to neutralize invasion by Salmonella enterica serovar Typhimurium. We characterized and compared the biofilm and planktonic communities within these microcosms using automated ribotyping and the Analytical Profile Index biotyping system. Eleven species from eight different genera were identified from six culture systems. Klebsiella pneumoniae was isolated from all planktonic communities and four of the biofilm communities. Three of the communities resisted colonization by Salmonella enterica serovar Typhimurium, two communities suppressed growth, and one community succumbed to colonization. In cultures that resisted colonization, no Salmonella could be isolated from the biofilm; in cultures that succumbed to colonization, Salmonella was consistently found within the biofilms. This study was one of a series that provided a molecular-based characterization of both the biofilm and planktonic communities from continuous-flow culture systems derived from the cecal microflora of chicks, ranging in age from day-of-hatch to 14 days old. The one common factor relating to successful colonization of the culture was the presence of Salmonella within the biofilm. The capacity to sequester the introduced Salmonella into the biofilm appears to be a contributing factor to the inability Of these cultures to withstand colonization by the Salmonella. [ABSTRACT FROM AUTHOR]

Patients are the best source of information about how they feel and how care affects them. Patient-reported outcome measures (PROMs) are standardized, validated questionnaires completed by patients to measure their perception of their well-being and health status. Aim : To create a cost-effective, valid, and sensitive PROMs data capture process for patients with Advanced Heart Failure (AHF) to understand to what extent a Heart Transplant (HT) affects their quality of life A prospective data collection model has been designed for AHF patients eligible for HT based on the Outcomes Management and Evaluation (OME) system developed by Cleveland Clinic. Two types of data will be collected: 1) Patient condition-specific PROMs; 2) OME for HT and potential Bridge to Transplant Therapies (BTT). Patient condition-specific PROMs will be measured using the Kansas City Cardiomyopathy Questionnaire and social determinants of health (e.g., smoking habits and drug abuse). The OME data for BTT include: A)Pre-BTT details (e.g., UNOS status),B)Post-BTT details (e.g., post-transplant mechanical support). The OME data for HT include:A)Pre-transplant details (e.g., UNOS status),B)Donor characteristics (e.g., ischemic trigger greater than 4 hours),C)Post-transplant details (e.g., post-transplant mechanical support). The process for collecting PROMs is divided into 5 phases (see fig). Data will start to be collected approximately in November 2020 until June 2021, aiming to have the first results analyzed by July 2021 This is one of the first PROMs processes implemented in an AHF program to the best of our knowledge. Our goal is to imbed PROMs into our workflow and create an umbrella of PROMs across the entire Heart and Vascular Institute to measure the quality of care from our patients' perspective to improve the clinical decision-making process. [ABSTRACT FROM AUTHOR]

The 2018 UNOS heart allocation system aims to enhance donor hearts access for most critically compromised patients (Pts). The SCAI classification describes severity of Pts in cardiogenic shock (CS). We aimed to study the value of SCAI stages, and evolving strategies of temporary mechanical circulatory support (tMCS) on Pts receiving heart transplant (HTX) in our center. This is a single institution retrospective study on Pts receiving HTX from October 2014 to October 2022, comparing demographics, clinical characteristics, SCAI CS stages, tMCS utilization, and early post-HTX outcomes before (group A) and after (group B) implementation of 2018 UNOS heart allocation system. Pts were classified according to SCAI stage at time of listing, hospital admission, and day of HTX. 217 Pts received HTX over 8 years, including 81 in group A and 136 in B. There was no difference in demographics (male sex 81.5% vs 76.5%; and mean age59.6 vs 57 years for groups A and B p=NS). At time of HTX, Pts in group B were more frequently in SCAI CS stage D or E (47% vs 12%, and 8.8% vs 1.2%, p<0.001) than group A. Group B Pts demonstrated worsening trajectory of CS from time of admission to HTX (48.5% vs 12.3%, p<0.001), and required more frequent initiation-escalation of tMCS (IABP 40.5% vs 2.5%, Impella 13.25% vs 5%, VAECMO 6.6% vs 0% p<0.0001). Length of hospital stay (LOS) was longer group B than A (38.2 vs 24.5 days, p<0.001), mainly due to increased pre-HTX LOS (16.4 vs 6.6 days, p<0.001), and to lesser extent in post-HTX period (22 vs 18 days, p<0.04). PostHTX complications were similar among groups (p>0.7), but tMCS was more frequent in group B (VAECMO 7.35% vs 5%, IABP 27% vs 3.7%, p<0.001), usually initiated preHTX. Worsening SCAI stage from admission to HTX was associated with inferior survival (p=0.03) in group B, but not in group A. SCAI stages of CS are a useful construct in pre-HTX Pts, correlates with severity of CS, requirement of tMCS, LOS, and HTX survival in the new allocation system. [ABSTRACT FROM AUTHOR]

Impella 5.5 is trans-aortic valve axial flow pump that provides over 6 L/min of blood flow. It received U.S. FDA approval in late 2019 to support cardiogenic shock (CS) patients up to 14 days. We present our initial clinical experience A retrospective review of CS patients receiving Impella 5.5 support over 18 months. Patient data included demographics, comorbidities, INTERMACS profile, SAVE score, patient and device complications, transition to long-term support or heart transplant, time of follow-up, and mortality rates. Multiple Kaplan-Meier survival analyses were based on age, CS status (INTRMACS and SAVE scores), body mass index (BMI), and time of follow-up. A t-test for two-samples was performed to establish statistical differences between age groups (<65 and >65 years), BMI groups (<30 and >30kg/m2), and transition of cardiac support and/or transplant. Finally, an ANOVA for single factor analysis was done for the different SAVE scores present (Class III, IV, and V). A total of 32 patients were predominantly white (91%) males (78%) with an average age and BMI of 58.7±17.6 years and 28.6±6.8 kg/m2, respectively. Most patients presented decompensated cardiogenic shock (INTERMACS I) at time of implant. 11 patients (34%) were bridged to heart transplant, 10 (31%) were upgraded to VA ECMO, and 5 to bi-ventricular Impella (16%). Patient /device complication rate was 25%. While age and transition groups showed no difference in survival rates (p =0.07 and p =0.3, respectively; CI 95%) patients with a BMI <30 kg/m2 showed better survival rates following intervention (p <0.01; CI: 95%). There was no difference between SAVE score groups III, IV, and V (p=0.5; CI:95%). 15 (47%) patients received physical therapy (5.5 ± 6.3 sessions / patient), with 13 (87%) of them progressing to heart transplantation. Impella 5.5 provided robust hemodynamic support for patients with severe cardiogenic shock, with over 50% hospital survival, including a third of patients bridged to heart transplant. [ABSTRACT FROM AUTHOR]

Lung transplant is considered a last resource surgical therapy for non-resolving COVID-19-associated acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific general population's interests. This study uses GT to analyze the United States (US) general population interest in LT as COVD-19/ARDS salvage therapy. GT was used to access data searched for the term lung transplant. The gathered information included data from January 2016 through October 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. The number of Google searches related to the term lung transplant has remained steady interest over time and surged in congruence with the appearance of COVID-19 in the US. From January 2016 until February 2019, interest has ranged from 29 to 58% (average 40%). Following the COVID-19 surge, average interest shifted up to 49%, with an all-time increase in November 2019, February 2020, and June 2020, of 90, 65 and 100%. Over time, the lead frequency of searches in sub-regions, metro areas, and cities, were Pennsylvania, Gainesville, FL, and Philadelphia, PA, respectively. Top related topic and top related query in search frequency, over time are electronic cigarette and lung transplant covid. At a glance, medical-relevant websites fail to provide adequate information for LT patient therapeutic education (PTE). GT complements the understanding of interest in LT, especially in consideration of the COVID-19 pandemic's perspective. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites. [ABSTRACT FROM AUTHOR]

Over 10 million major non-cardiac surgeries are performed yearly with a continuing and parallel increase of HF prevalence in the general population and the need to perform abdominal surgery (AS). Patients with advanced HF present severe mortality risk during AS. Heart transplant (HT) and AS guidelines consider the presence of multiple pathologies as contraindication for surgical treatment and the dual severity of these conditions has halted adequate therapy for patients with advanced HF. Transvalvular axial-flow pumps (TVAFP) provide hemodynamic stability and support patients with advanced HF receiving AS. The authors herein present the initial experience with AS in patients with decompensated HF under TVAFP support. A retrospective review of patients undergoing AS under TVAFP was conducted. Basic demographics, type of AS, time on support, transition to other supportive devices, outcomes, and mortality rates are reported. Four patients received AS while supported with TVAFP. The patients were predominantly male (75%) with an age, body mass index, and cardiac index average of 36.8±17.8 years, 37.9±11.3 kg/m2, and 1.7±0.2 L/min/m2, respectively. The average time and discontinuance of TVAFP support was 4±22.5 days following insertion. Length of stay, total weight loss and BMI at last encounter averages were 50.5±29.5 days, 60.5±32.4 lbs., and 30.6 kg/m2, respectively. All patients were discharged home alive, with 2 patients receiving HT during index admission, and 2 patients listed for HT within 3 months of AS. The average time from TVAFP support to HT listing, performance of HT, and follow-up after HT, were 118.8±118.9 days, 239±163, and 225±99.5 days, respectively. The combined surgical approach employing TVAFP hemodynamic support during AS represents a safe, and effective strategy for advanced HF patients. Further studies are necessary to confirm these initial observations. [ABSTRACT FROM AUTHOR]

Physical functioning in patients undergoing extracorporeal membrane oxygenation (ECMO) related to strict bedrest requirements is debilitating. Physical therapy (PT) in these patients can be beneficial. However, the data in COVID-19 associated with acute respiratory distress syndrome (ARDS) is not well characterized. We present our experience with ambulation in patients receiving veno-arterial-venous (VAV) ECMO support. Clinical charts of COVID-19 associated ARDS patients with VAV-ECMO support who received PT sessions between January 2021 and October 2021 were retrospectively reviewed and analyzed. Mobility functions were assessed. Episodes of oxygen saturation and hypotension were noted as primary outcomes. Eight patients were placed on VAV-ECMO for decompensated heart failure with right axillary artery cannulation via vascular graft and right internal jugular vein double lumen (Avalon) cannula. Mean age was 46.9 ± 10.3 years, and BMI was 30.6 ± 4.4 kg/m2 with five males. Mean duration of ECMO support was 53.6 ± 13.4 days. Average PT sessions per patient were 22.8 ± 12.2, with average days to PT initiation from ECMO insertion being 19.0 ± 8.1 days. The total average time per daily PT session was 27.2 ± 9.3 minutes. The ability to perform mobility functions with minimal, moderate, total, stand-by, contact-guard assistance for all patients is listed in the table. During PT sessions, a total of 14 episodes of oxygen desaturation and six episodes of hypotension in four patients were noted. There were no events of any cannula displacement. Of all, three are still in the hospital supported by ECMO, three transferred to the lung transplant center, one died in hospital, and one discharged home. VAV ECMO support via right axillary and RIJ dual lumen cannulation provides a safe strategy for prolonging support and effective rehabilitation in severe COVID-19 related ARDS patients complicated with RV failure. [ABSTRACT FROM AUTHOR]

The use of mesenchymal stromal cells (MSC) was recently proposed as a promising intervention for COVID-19 related respiratory failure (RF). Prior studies have suggested that its larger size might lead to entrapment in extracorporeal membrane oxygenation (ECMO), affect circuit function, and attenuate its efficacy. We present a successful case of a severe COVID-19 patient treated with MSC-derived exosomes while receiving veno-venous (VV) ECMO support. 41-year-old unvaccinated obese White male with no past medical history presenting with shortness of breath and a +COVID-19 nasopharyngeal test was admitted receiving high-flow nasal cannula (HFNC), remdesivir, and dexamethasone (Day 1), followed by intubation (day 5), and a peripheral VV ECMO insertion (day 10) due to worsening RF. We used bivalirudin for post-ECMO anticoagulation. Subsequently, he received the first cycle of MSC-derived exosomes on alternative days (day 1, 3, & 5) between days 13-17, followed by the second cycle between days 34-38. After administration of exosomes, the plasma concentration of inflammatory markers reduced, including a decrease of 77% for ferritin, 74% for CRP, and 62% for procalcitonin in approximately one week, along with consistent improvement of PaO 2 /FiO 2 ratio. ECMO membrane oxygenator was exchanged on day 23 at the time of tracheostomy. After successful weaning, ECMO decannulation was performed on day 47, and the patient was discharged home on day 61. ECMO has emerged as a supportive strategy for patients with severe COVID-19 related RF. The patient's inflammatory response has been implicated in the pathophysiology of lung failure. Multiple pharmacological methods are employed to control the severity of this inflammatory response, thus preventing progression to the fibrotic stage of the disease. In our experience, MSC-derived exosomes neither resulted in any side effects nor impaired the function of ECMO and might have enhanced the recovery of the patient. [ABSTRACT FROM AUTHOR]

Fluctuations in hormonal levels can alter cardiac myocytes at the cellular level, often resulting in deterioration of cardiac function. Endocrine cardiomyopathies have been described in the setting of hypo/hyperthyroidism, GH deficiency, acromegaly, and diabetes. However, it is rarely described in the setting of autoimmune polyglandular syndrome (APS). A 19 year-old male with a PMH of APS associated with hypothyroidism and adrenal insufficiency. He initially presented to an outside facility after a syncopal episode. Initial workup revealed a TSH of 70 and he was started on appropriate therapy. Soon after admission, he developed acute hypoxemic respiratory failure requiring urgent intubation. Due to severe pulmonary edema, an echo was obtained which revealed a severely decreased EF of 20%. An Impella CP® and Swan Ganz catheter were placed for management of cardiogenic shock. Due to persistent clinical deterioration with worsening renal and hepatic function, he underwent RPella® placement. Two days later he was transferred to our hospital for consideration of advanced Heart Failure therapies. Upon transfer, he was maintained on appropriate hormone therapies by endocrinology. An endomyocardial biopsy was unrevealing. We started low dose diuretics and noted marked improvement in right sided parameters with improving central venous pressures and resolving transaminitis. Repeat echo revealed normal right ventricular systolic function. The RPella® was then weaned off and electively removed. The Impella CP® device was weaned daily as per protocol. EF improved to 30% on repeat echo. Cardiac MRI was nonspecific. He was downgraded from ICU status after tolerance of comprehensive guideline based medical therapy. Previously described is a 32 year old male with a history of APS who developed severe biventricular failure requiring inotropic support, counterpulsation, mechanical circulatory support (MCS), and ultimately cardiac transplantation. Though our patient presented to us in a highly compromised state, the use of MCS helped bridge the patient to a recovery in myocardial performance while undergoing hormonal replacement. To our knowledge, this is the first case of its nature and highlights the possibility of temporary MCS in APS-associated cardiomyopathy, and in turn, can be useful in other secondary cardiomyopathies. [ABSTRACT FROM AUTHOR]