76 results on '"Jennifer S. Nelson"'
Search Results
2. Sex bias in CNS autoimmune disease mediated by androgen control of autoimmune regulator
- Author
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Meng-Lei Zhu, Pearl Bakhru, Bridget Conley, Jennifer S. Nelson, Meghan Free, Aaron Martin, Joshua Starmer, Elizabeth M. Wilson, and Maureen A. Su
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Science - Abstract
Males are less susceptible to autoimmune diseases due to immunomodulatory effects of androgen. Here the authors show that androgen receptor upregulates Aire and Aire-dependent transcription in the thymic epithelium, and that Aire is required for androgen-mediated suppression of experimental autoimmune encephalitis.
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- 2016
- Full Text
- View/download PDF
3. Paracorporeal Lung Devices: Thinking Outside the Box
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Timothy M. Maul, Jennifer S. Nelson, and Peter D. Wearden
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paracorporeal ,lung assist ,VAD ,oxygenator ,hybrid ,Pediatrics ,RJ1-570 - Abstract
Extracorporeal Membrane Oxygenation (ECMO) is a resource intensive, life-preserving support system that has seen ever-expanding clinical indications as technology and collective experience has matured. Clinicians caring for patients who develop pulmonary failure secondary to cardiac failure can find themselves in unique situations where traditional ECMO may not be the ideal clinical solution. Existing paracorporeal ventricular assist device (VAD) technology or unique patient physiologies offer the opportunity for thinking “outside the box.” Hybrid ECMO approaches include splicing oxygenators into paracorporeal VAD systems and alternative cannulation strategies to provide a staged approach to transition a patient from ECMO to a VAD. Alternative technologies include the adaptation of ECMO and extracorporeal CO2 removal systems for specific physiologies and pediatric aged patients. This chapter will focus on: (1) hybrid and alternative approaches to extracorporeal support for pulmonary failure, (2) patient selection and, (3) technical considerations of these therapies. By examining the successes and challenges of the relatively select patients treated with these approaches, we hope to spur appropriate research and development to expand the clinical armamentarium of extracorporeal technology.
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- 2018
- Full Text
- View/download PDF
4. Educating Surgeons to Construct Valved Conduits: What Does It Take to Achieve Reproducible Results?
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Shelby L. Aughtman, Peter D. Wearden, Mario Castro Medina, Timothy M. Maul, and Jennifer S. Nelson
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
5. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2022 Update on Outcomes and Research
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S. Ram Kumar, J. William Gaynor, Leigh Ann Jones, Carole Krohn, John E. Mayer, Meena Nathan, James E. O’Brien, Christian Pizarro, Chasity Wellnitz, and Jennifer S. Nelson
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
6. Capturing Adult Congenital Heart Disease: Framework for Development of an Adult Congenital Heart Disease Mortality Risk Model
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Eric N. Feins, Peter D. Wearden, Hani K. Najm, Stephanie Fuller, Jennifer S. Nelson, Yuli Y. Kim, Adil Husain, Tara Karamlou, Timothy M. Maul, Carl L. Backer, and Frank G. Scholl
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Adult ,Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Population ,Heart Valve Diseases ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Aortic valve replacement ,Interquartile range ,Internal medicine ,Humans ,Medicine ,education ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,education.field_of_study ,business.industry ,Mitral valve replacement ,Aortic Valve Stenosis ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,Aortic Valve ,Cohort ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background As a formative step toward development of adult congenital heart disease (ACHD) risk-adjusted metrics, we describe the STS ACHD population, procedural frequency, and early mortality. Methods Adults ( > 18 years) with CHD (2014-2019) were identified in the STS Adult Cardiac Surgery (ASCD) and the Congenital Heart Surgery (CHSD) Databases. Following deduplication, variable mapping, data concatenation, and harmonization of pre-procedure factors, procedures were grouped and unadjusted mortality catalogued for overall cohort and the cohort excluding patients with isolated bicuspid aortic valve (BAV). Results Among 171,186 ACSD and 18,281 CHSD records, 152,731 unique records met inclusion criteria. Twenty-eight congenital diagnoses accounted for 86% of the overall cohort, and prevalence of ACHD increased over the study timeframe. ACHD patients underwent operations to treat both acquired and CHD. Most common procedures overall and after excluding isolated BAV were: aortic valve replacement (AVR), ascending aortic surgery, and coronary artery bypass grafting (CABG). After excluding isolated BAV, major procedure combinations occurred in 46% (31% had 2 and 3% > 4 major procedures) and most prevalent combinations included: AVR + CABG (n=2,352), AVR + subaortic stenosis repair (n=1,481) and AVR + ascending aortic surgery (n=1,239). Unadjusted 30-day mortality was procedure dependent, 2.8% overall and 3.6% with isolated BAV excluded. Conclusions The ACHD surgical population is heterogenous, and patients undergo surgery for CHD-related and adult/acquired procedure combinations. Early mortality is variable and influenced by surgical complexity. Excluding isolated BAV patients and developing procedure-based ACHD mortality risk models may be ideal but will require empirically-derived grouping and collaboration.
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- 2022
7. Tetralogy of Fallot Associated With Right Aortic Arch and Isolated Left Brachiocephalic Artery
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Maya Hammonds, Thomas M. Knapp, Peace Madueme, Juan C. Infante, Elena Rueda-de-Leon, and Jennifer S. Nelson
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Pediatrics, Perinatology and Child Health ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
A newborn presented with tetralogy of Fallot (TOF), right aortic arch (RAA), and isolated left brachiocephalic artery. The RAA supplied the right common carotid artery, right vertebral artery, and right subclavian artery, in that order. The left common carotid and left subclavian arteries were in continuity with no aortic origin. Ultrasound demonstrated retrograde flow in the left vertebral artery supplying antegrade flow to the diminutive left subclavian artery (ie, “steal phenomenon”). The patient underwent repair of TOF without intervention on the left common carotid or left subclavian arteries and is being followed conservatively.
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- 2023
8. Commentary: Gender differences in payments to cardiothoracic surgeons are unacceptable
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Jeffrey P Jacobs, Jennifer S Nelson, Stephanie M Fuller, Mara B Antonoff, Tara Karamlou, Daniela Molena, Ourania Preventza, Shanda Blackmon, and Jennifer Romano
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Every effort must be made by the leaders in our field, as well as by every individual cardiothoracic surgeon, to assure equal opportunity for all cardiothoracic surgeons, regardless of race, gender or any other sociodemographic source of bias. Every effort must be made by every surgeon, not just those in particular leadership roles. Opportunities for advancement must be equal in multiple domains, including clinical practice, patient referral, clinical leadership, academic leadership, institutional leadership and leadership in professional medical and surgical societies. Such actions to minimize bias and promote inclusivity will also ensure that cardiothoracic surgical care is provided by a workforce that represents the diversity of patients whom we serve. In the final analysis, it is an absolute fact that gender differences in payments to cardiothoracic surgeons are absolutely unacceptable and cannot be tolerated.
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- 2023
9. Extracorporeal Life Support for Status Asthmaticus: Early Outcomes in Teens and Young Adults
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Krista N, Grennan, Timothy M, Maul, and Jennifer S, Nelson
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Adult ,Adolescent ,Status Asthmaticus ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine ,Biomaterials ,Young Adult ,Extracorporeal Membrane Oxygenation ,Treatment Outcome ,Humans ,Prospective Studies ,Registries ,Retrospective Studies - Abstract
Extracorporeal life support (ECLS) may be life saving for patients with status asthmaticus (SA), a difficult-to-treat, severe subset of asthma. Contemporary ECLS outcomes for SA in teens and young adults are not well described. The Extracorporeal Life Support Organization (ELSO) Registry was reviewed (2009-2019) for patients (15-35 years) with a primary diagnosis of SA. In-hospital mortality and complications were described. Multivariable logistic regression was used to identify independent risk factors for hospital mortality. Overall, 137 patients, (26 teens and 111 young adults; median age 25 years) were included. Extracorporeal life support utilization for SA sharply increased in 2010, coinciding with increased ECLS utilization overall. Median ECLS duration and length of stay were 97 hours and 11 days, respectively. In-hospital mortality and major complication rates were 10% and 11%, respectively. Nonsurvivors were more likely to have experienced ECLS complications, compared to survivors (86% vs. 42%, p = 0.003). Independent risk factors for in-hospital mortality included pre-ECLS arrest and any renal and/or neurologic complication. Prospective studies designed to evaluate complications and subsequent failure to rescue may help optimize quality improvement efforts.
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- 2022
10. Development of a Novel Society of Thoracic Surgeons Adult Congenital Mortality Risk Model
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Jennifer S. Nelson, Dylan Thibault, Sean M. O’Brien, Eric N. Feins, Jeffrey P. Jacobs, John E. Mayer, Hani K. Najm, David M. Shahian, Kevin D. Hill, Timothy M. Maul, Robert H. Habib, Jordan P. Bloom, and Tara Karamlou
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. Idiopathic Pericardial Effusions in Children: Workup and Final Diagnoses
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Emily R. Ribeiro, Christopher G. Hurtado, Thomas Knapp, Timothy M. Maul, and Jennifer S. Nelson
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Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine - Published
- 2022
12. Trends in Pulmonary Valve Replacement
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Jennifer S. Nelson, Emile Bacha, Diego Porras, and Stephanie Fuller
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
13. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery
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Stephanie Fuller, S. Ram Kumar, Nathalie Roy, William T. Mahle, Jennifer C. Romano, Jennifer S. Nelson, James M. Hammel, Michiaki Imamura, Haibo Zhang, Stephen E. Fremes, Sara McHugh-Grant, Susan C. Nicolson, Christopher A. Caldarone, Jonathan M. Chen, Todd K. Rosengart, and Sitaram M. Emani
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Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Consensus ,Time Factors ,Delphi Technique ,Cardiology ,Pediatrics ,law.invention ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Cardiac Surgical Procedures ,Dexmedetomidine ,Evidence-Based Medicine ,business.industry ,General surgery ,Age Factors ,Recovery of Function ,Evidence-based medicine ,Perioperative ,Intensive care unit ,Cardiac surgery ,Treatment Outcome ,Cardiothoracic surgery ,Deep hypothermic circulatory arrest ,Surgery ,Enhanced Recovery After Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
14. Three-Dimensional Modeling Prior to Stage 1 Palliation in a Patient With Heterotaxy Syndrome: Planning for the Future
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John Jayman, Shelby Aughtman, Pushpak Patel, Peace C. Madueme, Craig Johnson, and Jennifer S. Nelson
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Heart Defects, Congenital ,Heart Ventricles ,Palliative Care ,Humans ,Radiology, Nuclear Medicine and imaging ,Heterotaxy Syndrome ,Cardiology and Cardiovascular Medicine - Published
- 2022
15. Comparison of DNA methylation patterns across tissue types in infants with tetralogy of Fallot
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Jennifer S. Nelson, Cheuk Kwok, Nicholas E. Braganca, Daralys L. Lopez, Andrea P. Espina Rey, Matthew Robinson, and Steven N. Ebert
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Embryology ,Cytosine ,Guanine ,Health, Toxicology and Mutagenesis ,Pediatrics, Perinatology and Child Health ,Mouth Mucosa ,Tetralogy of Fallot ,Humans ,Infant ,DNA Methylation ,Toxicology ,Developmental Biology ,Phosphates - Abstract
Environmental factors may influence the development of tetralogy of Fallot (TOF), and DNA methylation patterns may reveal specific chemical signatures of perturbations during cardiac development. We investigated whether blood and buccal cells could be viable surrogates for myocardium.We measured epigenome-wide DNA methylation at 866,895 5'-cytosine-phosphate-guanine-3' (CpG) sites in blood (n=3), buccal cells (n=3), and right ventricular myocardium (n=4) collected from infants with TOF and compared the percent of differentially methylated CpG sites across tissue types. Gene-specific DNA methylation profiles were also analyzed for ten representative genes associated with heart development. Welch's ANOVAs compared general methylation between tissue types.Comparison of DNA methylation profiles across blood, buccal, and myocardium suggested myocardium and buccal samples were most similar, differing in DNA methylation at only 1.3% (11,386) of CpG sites whereas myocardium and blood were most dissimilar, having 146,857 statistically dissimilar methylated CpG sites (~17% dissimilarity; adjusted p0.01 for each site). Buccal swabs were significantly more variable (p.001) than either blood or myocardial samples. In gene-specific analyses, SCO2, GATA4, NOTCH4, WNT7A, and DKK2 showed conserved DNA methylation profiles across tissue types, while HAND1, JAG1, NKX2-5, TBX5 and TBX20 showed more distinctive tissue-specific patterns of DNA methylation.Compared with blood, buccal tissue more closely mirrors the myocardial methylome, with10-fold similarity. Nevertheless, both buccal and blood tissue capture highly conserved DNA methylation patterns at specific genetic loci related to cardiac development. Buccal cheek swabs may be a useful surrogate tissue type for future investigations of TOF-specific epigenetic profiles.
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- 2022
16. Aortic Valve Replacement in Young and Middle-Aged Adults: Current and Potential Roles of TAVR
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Tara Karamlou, Jennifer S. Nelson, Timothy M. Maul, Hani K. Najm, Peter D. Wearden, Douglas R. Johnston, and Orkun Baloglu
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Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Databases, Factual ,Population ,030204 cardiovascular system & hematology ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Bicuspid aortic valve ,Aortic valve replacement ,Interquartile range ,Humans ,Medicine ,education ,Stroke ,Heart Valve Prosthesis Implantation ,education.field_of_study ,business.industry ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Cardiac surgery ,medicine.anatomical_structure ,030228 respiratory system ,Aortic Valve ,Heart Valve Prosthesis ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Contemporary practice patterns and outcomes for aortic valve replacement (AVR) among young and middle-aged adults are unknown given guideline modifications for surgical AVR (SAVR) and increasing transcatheter AVR (TAVR) acceptance. This study describes SAVR and TAVR use and outcomes using The Society of Thoracic Surgeons (STS) National Databases. Methods Adults 18 to 55 years of age in the Congenital Heart Surgery Database (CHSD) and the Adult Cardiac Surgery Database (ACSD) who underwent SAVR or TAVR from 2013 to 2018 were included. Perioperative characteristics and early outcomes were described by valve type. Multivariable regression identified determinants of death, length of hospital stay, and a composite end point of renal failure, persistent neurologic deficit, readmission, and reoperation. Results The study analyzed 1580 unique CHSD and 44,173 ACSD operations, 16% of which were performed in patients with congenital heart disease. Valve use included the following: TAVR, 1%; mechanical, 42%; bioprosthetic, 55%; autograft, 0.6%; homograft, 1.2%; and Ozaki, 0.4%. Over time, TAVR volumes increased by 167%. The 30-day mortality was as follows: TAVR, 3.8%; mechanical, 3.2%; bioprosthetic, 3.7%; autograft, 0.6%; homograft, 9%; and Ozaki, 3.4%. Stroke rate was lower for isolated SAVR vs isolated TAVR (0.9% vs 2.4%; P = .002). In multivariable analyses, mortality risk was lower with mechanical valves, congenital morbidity risk was higher with TAVR, and length of stay was shorter with TAVR. Conclusions TAVR is increasingly used for adults younger than 55 years of age. Given the uniformly excellent results with SAVR, including both mortality and morbidity—particularly regarding stroke, our data favor SAVR in this population, but a prospective trial is needed. Ongoing efforts to harmonize variables and outcomes definitions between the ACSD and CHSD are valuable.
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- 2021
17. G Is for Geometric: A G-Chart Primer for Surgeons
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Jennifer S. Nelson
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. Commentary: Goldi-Ross and the 3 VSRRs
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Jennifer S, Nelson
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
19. Discussion
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Jennifer S, Nelson
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
20. A 22-Month-Old Girl With 3 Weeks of Dyspnea
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Jennifer S. Nelson, John T. Kennedy, Katherine T. Braley, and Peter D. Wearden
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Pulmonary and Respiratory Medicine ,media_common.quotation_subject ,Critical Care and Intensive Care Medicine ,Azithromycin ,Irritability ,Tachypnea ,Decreased urine output ,03 medical and health sciences ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,Girl ,media_common ,medicine.diagnostic_test ,business.industry ,Amoxicillin ,medicine.disease ,respiratory tract diseases ,Pneumonia ,030228 respiratory system ,Anesthesia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Chest radiograph ,business ,medicine.drug - Abstract
Case Presentation A previously healthy 22-month-old girl presented to the ED with a 3-week history of dyspnea on exertion. A chest radiograph showed a right upper-lobe opacity suspicious for pneumonia ( Fig 1 A). The patient was prescribed amoxicillin but returned to the ED 7 days later with cough and persistent dyspnea and tachypnea. At that time, a repeat chest radiograph was concerning for worsening pneumonia ( Fig 1 B). Treatment with azithromycin and albuterol was initiated, and amoxicillin was discontinued. Her symptoms briefly improved; however, she returned to the ED 10 days later because of worsening cough and tachypnea, and a 2-day history of increased irritability, decreased oral intake, decreased urine output, and intermittent perioral cyanosis. She was afebrile throughout this period per parent report and vital sign documentation at each ED visit.
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- 2020
21. Concurrent double aortic arch and circumflex aorta repair in a symptomatic child: a case report
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Christopher G. Hurtado and Jennifer S. Nelson
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Pulmonary and Respiratory Medicine ,Diverticulum ,Humans ,Surgery ,Aorta, Thoracic ,General Medicine ,Cardiology and Cardiovascular Medicine ,Child ,Vascular Ring ,Vascular Surgical Procedures ,Aorta - Abstract
Double aortic arch with circumflex aorta is a rare type of vascular ring. Symptoms result from external compression of the trachea and esophagus. The best surgical approach for patients with double arch and circumflex aorta is debated, and options include the highly complex aortic uncrossing procedure. Herein we describe the surgical treatment of a patient with concurrent double aortic arch and circumflex aorta by division of the non-dominant arch and ligamentum arteriosum, plication and posterior tacking of the diverticulum of Kommerell. This left thoracotomy approach provided complete symptom resolution.
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- 2021
22. Assessment of Current Society of Thoracic Surgeons Data Elements for Adults With Congenital Heart Disease
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Jennifer S. Nelson, Jeffrey P. Jacobs, Castigliano M. Bhamidipati, Leora T. Yarboro, S. Ram Kumar, Donna McDonald, Carole Krohn, Leigh Ann Jones, John E. Mayer, and Frank G. Scholl
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Pulmonary and Respiratory Medicine ,Adult ,Heart Defects, Congenital ,Surgeons ,Adolescent ,Databases, Factual ,Outcome Assessment, Health Care ,Humans ,Thoracic Surgery ,Surgery ,Cardiology and Cardiovascular Medicine ,Societies, Medical - Abstract
To identify opportunities for enhanced data collection for adults with congenital heart disease (ACHD), a structured review of existing variables in The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) and the STS Adult Cardiac Surgery Database (ACSD) was conducted.A working group was assembled representing multiple STS Workforces and Task Forces. The ACSD was reviewed systematically over eight 90-minute calls. ACSD version 4.20.2 and CHSD version 3.41 were used, and the ACSD was approached in sections. ACSD variables were classified as (1) represented in identical form in the CHSD (no further discussion), (2) represented in similar form in the CHSD (discussed for potential harmonization of definitions), or (3) not represented in the CHSD (discussed for potential inclusion). Variables felt to be relevant to ACHD were noted, and special consideration was given to STS required fields and variables used in existing STS adult risk models. Other factors that were examined were the frequency, use, and capture of existing ACSD variables.Over 22 weeks (8 calls), the existing 1069 variables in version 4.20.2 of the ACSD were discussed. Ultimately, 539 total variables were found to be both (1) relevant to ACHD and (2) not currently collected in the CHSD. These were recommended for inclusion in the next CHSD upgrade for patients aged ≥18 years.For adult patients having case records entered into the CHSD, the inclusion of a limited set of additional data fields from the ACSD should enhance capture of comorbidities and other clinical data relevant to the ACHD population.
- Published
- 2021
23. Surgery for Dysphagia Lusoria in Children
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Jennifer S. Nelson, Peter D. Wearden, and Christopher G. Hurtado
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Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiovascular Abnormalities ,Subclavian Artery ,Dysphagia lusoria ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Right Common Carotid Artery ,medicine.artery ,medicine ,Humans ,Thoracotomy ,Arteria lusoria ,Child ,Ultrasonography, Doppler, Duplex ,business.industry ,medicine.disease ,Dysphagia ,Surgery ,030228 respiratory system ,Median sternotomy ,Child, Preschool ,medicine.symptom ,Deglutition Disorders ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Surgical interventions ,Follow-Up Studies - Abstract
Aberrant right subclavian artery, or arteria lusoria, is a common congenital anomaly of the aortic arch and may be associated with dysphagia. Surgical treatment, particularly in children, remains controversial. Current surgical interventions include supraclavicular and thoracotomy approaches, as well as hybrid endovascular techniques. However, these techniques have significant limitations and varying degrees of success. This case report describes a 2-site operation whereby the arteria lusoria is transected via a left thoracotomy and subsequently re-implanted into the right common carotid artery via a median sternotomy. This approach has provided complete symptom resolution for dysphagia lusoria in 2 children.
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- 2020
24. Early arrhythmia burden in pediatric cardiac surgery fast-track candidates: Analysis of incidence and risk factors
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Jennifer S. Nelson, Jennifer K. Whitham, Sunita J. Ferns, Timothy M. Maul, and Swetha Vanja
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medicine.medical_specialty ,Heart disease ,business.industry ,Heart block ,Perioperative ,030204 cardiovascular system & hematology ,medicine.disease ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Bypass surgery ,030225 pediatrics ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Junctional ectopic tachycardia ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Atrial tachycardia - Abstract
An increasing number of pediatric heart centers are utilizing early extubation protocols to “fast-track” patients after congenital heart surgery. Early postoperative arrhythmias are an important recognized complication of pediatric heart surgery, but the arrhythmia burden among candidates for extubation immediately after bypass surgery is unknown. This study evaluated the incidence and risk factors associated with postoperative arrhythmias in surgical fast-track candidates. Postoperative rhythm status and potential perioperative risk factors were retrospectively analyzed in all patients undergoing surgery for congenital heart disease from 2012 to 2014 who were considered early extubation candidates. Overall, 199 operations in 196 individual patients (30 days–19 years) were included. The overall incidence of arrhythmias was 9% (18/199). The most common arrhythmia was junctional ectopic tachycardia (5%; 10/199), followed by atrial tachycardia (1.5%; 3/199) and complete heart block (1.5%; 3/199). Two patients with junctional ectopic tachycardia had permanent complete heart block. Compared to patients with no arrhythmias, patients with arrhythmias were more likely to be younger (0.5 vs. 2.4 years, U = 783, p Early postoperative arrhythmias are common among fast-track candidates. Patient age and operation complexity may predict risk of early arrhythmia. These data provide important information to help guide programmatic and clinical decision-making when contemplating fast tracking children after congenital heart surgery.
- Published
- 2019
25. Aortic arch atresia in Williams syndrome
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Stefanie M. Miller, Peace C. Madueme, Peter D. Wearden, and Jennifer S. Nelson
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Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine - Published
- 2022
26. Preparation of children with heart disease for diagnostic and therapeutic procedures requiring anesthesia
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Brian J. Gronert, Benjamin Yitzhak, Jennifer S. Nelson, and Karen S. Bender
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Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine - Published
- 2022
27. Preoperative imaging and surgical repair of a coronary sinus septal defect: A case report
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Gabriel Krivenko, Brenden Maag, Jennifer S. Nelson, Peace Madueme, Kathryn Douglas, and Maria Malaya Dorotan-Guevara
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Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine - Published
- 2022
28. An examination of the differential susceptibility pattern of the dentition to linear enamel hypoplasia
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Jennifer S Nelson
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Orthodontics ,Molar ,060101 anthropology ,Enamel defects ,Dentition ,medicine.medical_treatment ,030206 dentistry ,06 humanities and the arts ,Enamel hypoplasia ,Biology ,medicine.disease ,Hypoplasia ,Crown (dentistry) ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,medicine ,General Earth and Planetary Sciences ,0601 history and archaeology ,Anterior teeth ,General Environmental Science ,Susceptibility pattern - Abstract
Enamel hypoplasia is a dental pathology that forms when an individual is exposed to physiological stress in early life while tooth crowns are developing. Biological anthropologists utilize these enamel defects as indicators of growth interruption and interpret them as reflective of factors pertaining to health status and cultural practices that influence health. Over decades of research, numerous studies have noted a pattern in the distribution of linear enamel hypoplasia across the dentition. It is suggested that the anterior dentition presents the highest frequency of defects, followed by the premolars, with molars most rarely exhibiting hypoplasia. This apparent differential susceptibility pattern has resulted in the preferential study of the anterior dentition in anthropology, however little research has been conducted into the validity or cause of this developmental phenomenon. Through examination of the literature, the observed higher frequency of enam2el hypoplasia in the anterior dentition substantiates the existence of this differential distribution pattern. Further investigation reveals that the cause of this varying susceptibility has not been sufficiently explored, leading to a number of inconclusive explanations. Examination of these theories – ranging from the chronology of tooth development, specifics of crown morphology, and variations in genetic control – indicate that there is no single causal variable, but that a multitude of factors are responsible. From this research it is apparent that further study is necessary to fully understand why the anterior teeth appear to be more susceptible to hypoplastic defects than their posterior counterparts.
- Published
- 2018
29. A shifting landscape: Practice patterns and outcomes of cystic fibrosis and non-cystic fibrosis pediatric lung transplantation
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Shelby L Aughtman, Timothy M. Maul, Jennifer S. Nelson, Christopher G. Hurtado, and Peter D. Wearden
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Inotrope ,Graft Rejection ,Male ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,medicine.medical_treatment ,Cystic fibrosis ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Lung transplantation ,Humans ,Registries ,Risk factor ,Practice Patterns, Physicians' ,Child ,Retrospective Studies ,Transplantation ,Lung ,Practice patterns ,business.industry ,Graft Survival ,Infant ,medicine.disease ,Pulmonary hypertension ,Survival Analysis ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Lung Transplantation - Abstract
BACKGROUND New drugs may further decrease the need for lung transplant (LTx) in pediatric patients with cystic fibrosis (CF), but few studies highlight pediatric non-CF LTx characteristics and outcomes. METHODS The ISHLT registry was used to report morbidity, graft failure, and survival for primary pediatric (
- Published
- 2021
30. Does age estimated from teeth forming in different early life periods show differential discrepancy with known age?
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Hugo F.V. Cardoso, Lesley Harrington, Emily Holland, and Jennifer S Nelson
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Male ,Adolescent ,Age prediction ,030209 endocrinology & metabolism ,Biology ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Genetics ,Deciduous teeth ,medicine ,Humans ,0601 history and archaeology ,Child ,Ecology, Evolution, Behavior and Systematics ,Permanent teeth ,060101 anthropology ,Permanent tooth ,Dentition ,Age Factors ,Infant ,06 humanities and the arts ,Dental age ,Early life ,stomatognathic diseases ,medicine.anatomical_structure ,Deciduous ,Italy ,Child, Preschool ,Anthropology ,Female ,Age Determination by Teeth ,Anatomy ,Tooth ,Demography - Abstract
OBJECTIVES The aim of this study is to explore growth discrepancies in the dentition of impoverished children and examine how dental development is impacted by environmental influences throughout childhood, thereby identifying which teeth are more sensitive to the effects of biocultural factors and are consequently less useful to predict age. METHODS Length measurements of developing teeth (deciduous and permanent) were taken from individuals of known age and sex (n = 61) from the Certosa collection, a 19th century skeletal assemblage representing Italian children of low socioeconomic status. Discrepancies between age estimates based on tooth length and chronological age were calculated, and the accuracy and precision of age prediction between earlier forming teeth and later forming teeth were compared. RESULTS Deciduous teeth produced more precise dental age estimates (mean age discrepancy -0.092 years), while discrepancies between chronological age and age based on developing permanent dentition were larger (-0.628 years). The difference between these discrepancies in age estimates for deciduous and permanent teeth was significant (p
- Published
- 2021
31. Time-Related Risk of Pulmonary Conduit Re-replacement: A Congenital Heart Surgeons' Society Study
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Nabi Aghaei, Aaron W. Eckhauser, Brian W. McCrindle, Eugene H. Blackstone, Tara Karamlou, Jeremy L. Herrmann, James K. Kirklin, John W. Brown, Christopher W. Baird, James D St Louis, Linda M. Lambert, Connor P Callahan, Anusha Jegatheeswaran, Karthik Ramakrishnan, William M. DeCampli, Anastasios C. Polimenakos, and Jennifer S. Nelson
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Male ,endocrine system ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Heart Ventricles ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Competing risks ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Electrical conduit ,medicine.artery ,Medicine ,Humans ,Cardiac Surgical Procedures ,Child ,Societies, Medical ,Retrospective Studies ,business.industry ,Hazard ratio ,Anastomosis, Surgical ,Infant, Newborn ,Infant ,Thoracic Surgery ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Pulmonary valve ,Child, Preschool ,Pulmonary artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Follow-Up Studies - Abstract
Patients receiving a right ventricle to pulmonary artery conduit (PC) in infancy will require successive procedures or replacements, each with variable longevity. We sought to identify factors associated with time-related risk of a subsequent surgical replacement (PC3) or transcatheter pulmonary valve insertion (TPVI) after a second surgically placed PC (PC2).From 2002 to 2016, 630 patients from 29 Congenital Heart Surgeons' Society member institutions survived to discharge after initial valved PC insertion (PC1) at age ≤ 2 years. Of those, 355 underwent surgical replacement (PC2) of that initial conduit. Competing risk methodology and multiphase parametric hazard analyses were used to identify factors associated with time-related risk of PC3 or TPVI.Of 355 PC2 patients (median follow-up, 5.3 years), 65 underwent PC3 and 41 TPVI. Factors at PC2 associated with increased time-related risk of PC3 were smaller PC2 Z score (hazard ratio [HR] 1.6, P.001), concomitant aortic valve intervention (HR 7.6, P = .009), aortic allograft (HR 2.2, P = .008), younger age (HR 1.4, P.001), and larger Z score of PC1 (HR 1.2, P = .04). Factors at PC2 associated with increased time-related risk of TPVI were aortic allograft (HR: 3.3, P = .006), porcine unstented conduit (HR 4.7, P.001), and older age (HR 2.3, P = .01).Aortic allograft as PC2 was associated with increased time-related risk of both PC3 and TPVI. Surgeons may reduce risk of these subsequent procedures by not selecting an aortic homograft at PC2, and by oversizing the conduit when anatomically feasible.
- Published
- 2021
32. Tetralogy of Fallot
- Author
-
Jennifer C. Hirsch-Romano, Jennifer S. Nelson, and Edward L. Bove
- Subjects
Surgical repair ,medicine.medical_specialty ,Complete atrioventricular septal defect ,business.industry ,medicine.disease ,Low cardiac output syndrome ,Absent pulmonary valve ,Internal medicine ,Pulmonary Valve Replacement ,medicine ,Cardiology ,Pulmonary blood flow ,Pulmonary atresia ,business ,Tetralogy of Fallot - Published
- 2020
33. A Minimal Opioid Postoperative Management Protocol in Congenital Cardiac Surgery: Safe and Effective
- Author
-
Adam W. Lowry, Peter D. Wearden, Constantinos Chrysostomou, William C. Frankel, Jennifer S. Nelson, Kimberly N. Baker, and Timothy M. Maul
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Dexmedetomidine ,Cardiac Surgical Procedures ,Child ,Retrospective Studies ,Pain, Postoperative ,business.industry ,General Medicine ,Cardiac surgery ,Ketorolac ,Analgesics, Opioid ,Treatment Outcome ,030228 respiratory system ,Opioid ,Median sternotomy ,Anesthesia ,Child, Preschool ,Coronary care unit ,Airway Extubation ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
There is evidence that reducing opioid exposure in children undergoing cardiac surgery may enhance postoperative recovery. We aimed to describe a minimal opioid postoperative management protocol in children undergoing cardiac surgery and our early outcomes with this strategy. We reviewed the medical records of children (6 months-18 years) who underwent elective cardiac surgery through a median sternotomy with cardiopulmonary bypass at our institution between 2016 and 2018. All patients were managed postoperatively using a standardized protocol. 101 children (median age 5 years) were included and 85% were extubated in the operating room. Although most patients (96%) received opioids postoperatively, opioid requirements decreased steadily over time, with 88%, 58%, and 18% of children receiving opioids on postoperative day 1, 2, and 3, respectively; 41% received no opioids after postoperative day 1. The median cumulative opioid exposure was 0.25 morphine milligram equivalents per kg (interquartile range, 0.10-0.75). Greater than mild pain was rare (10%) at each time point. The rates of operative mortality and major complication were 0% and 3%, respectively. The median postoperative length of stay was 3 days, and 13% required readmission within 30 days. Age, cardiopulmonary bypass time, and number of benzodiazepine doses were independently associated with cumulative opioid exposure. Any complication, chest tube time, and higher STAT Category were independently associated with prolonged postoperative length of stay. A minimal opioid postoperative management protocol can be safe and effective in children undergoing cardiac surgery. Future prospective studies are needed to determine optimal practice and patient selection.
- Published
- 2020
34. Association of atrial septal fenestration with outcomes after atrioventricular septal defect repair
- Author
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David M. Overman, Osami Honjo, Joseph W. Turek, Stephanie Fuller, Michael E. Mitchell, Jennifer S. Nelson, David J. Barron, William M. DeCampli, Eugene H. Blackstone, James K. Kirklin, Anastasios C. Polimenakos, Robert J. Dabal, Brian W. McCrindle, Andrew J. Toth, Christopher A. Caldarone, Karthik Ramakrishan, Anusha Jegatheeswaran, Tharini Paramananthan, Connor P. Callahan, Jeevanantham Rajeswaran, Pirooz Eghtesady, S. Adil Husain, Alistair Phillips, and Jeffrey P. Jacobs
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Canada ,medicine.medical_specialty ,Time Factors ,Routine practice ,Risk Assessment ,law.invention ,Risk Factors ,law ,medicine.artery ,Cardiopulmonary bypass ,Humans ,Medicine ,Prospective Studies ,Atrioventricular Septal Defect ,Cardiac Surgical Procedures ,Atrial Septum ,business.industry ,Heart Septal Defects ,Infant ,United States ,Surgery ,Treatment Outcome ,Cohort ,Pulmonary artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fenestration ,Left atrioventricular valve regurgitation ,Shunt (electrical) - Abstract
During repair of atrioventricular septal defect (AVSD), surgeons might leave an atrial level shunt when concerned about postoperative physiology, or as part of routine practice. However, the association of fenestration with outcomes is unclear. We sought to determine factors associated with mortality after biventricular repair of AVSD.We included 581 patients enrolled from 32 Congenital Heart Surgeons' Society institutions from January 1, 2012, to June 1, 2020 in the Congenital Heart Surgeons' Society AVSD cohort. Parametric multiphase hazard analysis was used to identify factors associated with mortality. A random effect model was used to account for possible intersite variability in mortality.An atrial fenestration was placed during repair in 133/581 (23%) patients. Overall 5-year survival after repair was 91%. Patients who had fenestration had an 83% 5-year survival versus 93% for those not fenestrated (P .001). Variables associated with mortality in multivariable hazard analysis included institutional diagnosis of ventricular unbalance (hazard ratio [HR], 2.7 [95% confidence interval (CI): 1.5-4.9]; P = .003), preoperative mechanical ventilation (HR, 4.1 [95% CI, 1.3-13.1]; P = .02), atrial fenestration (HR, 2.8 [95% CI, 1.5-4.9]; P .001), and reoperation for ventricular septal defect (HR, 4.0 [95% CI, 1.3-13.1]; P = .002). There was no difference in measures of ventricular unbalance for comparisons of fenestrated with nonfenestrated patients. No significant interinstitution variability in mortality was observed on the basis of the random effect model (P = .7).An atrial communication at biventricular repair of AVSD is associated with significantly reduced long-term survival after adjusting for other known associated factors, including unbalance. These findings might challenge the routine practice of fenestration.
- Published
- 2022
35. Persistent Double Dorsal Aorta Surrounding Large Neuroenteric Cyst
- Author
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Christopher G. Hurtado, Tamarah J. Westmoreland, Pushpak K. Patel, Peace C. Madueme, Andrea G. Scherer, Anna V. Sedney, and Jennifer S. Nelson
- Subjects
Pulmonary and Respiratory Medicine ,Humans ,Surgery ,Arteries ,Neural Tube Defects ,Cardiology and Cardiovascular Medicine ,Aorta - Published
- 2022
36. A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children
- Author
-
Olivia DiLeonardo, John T. Kennedy, Jennifer S. Nelson, and Christopher G. Hurtado
- Subjects
medicine.medical_specialty ,Sternum ,medicine.drug_class ,Antibiotics ,Patient characteristics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Internal medicine ,Cefazolin ,Medicine ,Humans ,Surgical Wound Infection ,Antibiotic prophylaxis ,Cardiac Surgical Procedures ,Child ,business.industry ,Incidence (epidemiology) ,General Medicine ,Antibiotic Prophylaxis ,Antimicrobial ,Cardiac surgery ,Anti-Bacterial Agents ,Regimen ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Antibiotic prophylaxis following delayed sternal closure in pediatric cardiac surgery is not standardized. We systematically reviewed relevant literature published between 1990 and 2019 to aid future trial design. Patient characteristics, antimicrobial prophylaxis regimens, and postoperative incidence of infection were collected. Twenty-eight studies described 36 different regimens in over 3,000 patients. There were 11 single-drug regimens and 25 multidrug regimens. Cefazolin-only was the most common regimen (9/36, 25%). The overall incidence of surgical site infection was 7.5% (217/2,910 patients) and bloodstream infection was 7.4% (123/1,667 patients). In the 2010s, multidrug regimens were associated with a significantly lower incidence of both surgical site infections (4.6% vs. 20%, P < .001) and bloodstream infections (6.0% vs. 50%, P < .001) compared to single-drug regimens.
- Published
- 2020
37. Coronary Artery Aneurysms as a Feature of Granulomatosis With Polyangiitis
- Author
-
Chavi Rehani and Jennifer S. Nelson
- Subjects
medicine.medical_specialty ,Cyclophosphamide ,Leukocytosis ,Neutrophils ,Magnetic Resonance Imaging, Cine ,Gastroenterology ,Fever of Unknown Origin ,Blood Urea Nitrogen ,03 medical and health sciences ,Necrosis ,0302 clinical medicine ,Glomerulonephritis ,Imaging, Three-Dimensional ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Fever of unknown origin ,Child ,Aspirin ,Heart Murmurs ,L-Lactate Dehydrogenase ,Genitourinary system ,business.industry ,Warfarin ,Coronary Aneurysm ,Granulomatosis with Polyangiitis ,medicine.disease ,Echocardiography ,Creatinine ,Pediatrics, Perinatology and Child Health ,Rituximab ,Female ,Granulomatosis with polyangiitis ,business ,Vasculitis ,medicine.drug - Abstract
Granulomatosis with polyangiitis is an antineutrophil cytoplasmic antibody–associated vasculitis that primarily affects small vessels. The disease typically affects the respiratory tract and kidneys but has also been known to involve the gastrointestinal tract, genitourinary tract, thyroid, and liver. Cardiac involvement is rare. Coronary artery aneurysms (CAAs) are an extremely uncommon finding, with only 1 reported case in an adult patient and no pediatric cases reported to date. Here, we report the unique case of a child with granulomatosis with polyangiitis who initially presented with fever of unknown origin and pulmonary and renal symptoms with no cardiac complaints. An echocardiogram revealed severe bilateral fusiform CAAs. Because of the high risk of mortality posed by the severity of her renal and cardiac disease, the patient was managed with intensive induction immunosuppression with steroids, rituximab, and cyclophosphamide. She is maintained on steroids, rituximab, aspirin, and warfarin with improved renal function but no change in her CAAs.
- Published
- 2020
38. Pediatric ECMO after drowning: Neuroprotective strategies
- Author
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Laufey Y. Sigurdardottir, Neha Longani, Timothy M. Maul, Jennifer S. Nelson, Peter D. Wearden, and Constantinos Chrysostomou
- Subjects
business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Hypothermia ,Return of spontaneous circulation ,Neuroprotection ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Erythropoietin ,Anesthesia ,Pediatrics, Perinatology and Child Health ,medicine ,Extracorporeal membrane oxygenation ,030212 general & internal medicine ,Dexmedetomidine ,medicine.symptom ,Toddler ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
There are no established neuroprotective guidelines during pediatric extracorporeal membrane oxygenation (ECMO) after cardiac arrest. We report a case of unknown duration, out-of-hospital cardiac arrest after drowning in a toddler. The patient experienced severe cardiopulmonary failure shortly after return of spontaneous circulation and required veno-arterial ECMO. Clinical outcome was excellent. This report outlines a neuroprotective strategy using high-dose erythropoietin, dexmedetomidine, and therapeutic hypothermia that was implemented during ECMO. Risk factors related to pediatric drowning with cardiac arrest are also discussed.
- Published
- 2018
39. Regional Differences in Cost and Length of Stay in Neonates with Hypoplastic Left Heart Syndrome
- Author
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Eric G. Jernigan, Jennifer S. Nelson, Paula D. Strassle, and Luma Essaid
- Subjects
Male ,Patient Transfer ,medicine.medical_specialty ,Pediatrics ,Databases, Factual ,Heart disease ,Geographic variation ,030204 cardiovascular system & hematology ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Hypoplastic Left Heart Syndrome ,medicine ,Humans ,business.industry ,Mortality rate ,Infant, Newborn ,Length of Stay ,Vascular surgery ,medicine.disease ,Hospital Charges ,United States ,Cardiac surgery ,Pediatrics, Perinatology and Child Health ,Linear Models ,Cost analysis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Regional differences - Abstract
Hypoplastic left heart syndrome (HLHS) is a highly resource-intensive diagnosis. Geographic variation in cost and length of stay (LOS) in HLHS is not well described. Neonates diagnosed with HLHS between 2000 and 2012 were identified using the Kids’ Inpatient Database. Hospitalizations were stratified into two groups: (1) birth and (2) secondary. United States regional differences in hospital charges and LOS were compared using adjusted linear regression. Of 2431 birth hospitalizations, 449 neonates (18.5%) died while inpatient and mortality rates differed by region (p = 0.02). After birth, 40.5% (n = 985) of neonates were transferred; transfers were most common in the Midwest (p
- Published
- 2018
40. Regional differences in right versus left congenital heart disease diagnoses in neonates in the United States
- Author
-
Paula D. Strassle and Jennifer S. Nelson
- Subjects
Heart Defects, Congenital ,Male ,Left and right ,Embryology ,Pediatrics ,medicine.medical_specialty ,Databases, Factual ,Heart disease ,Health, Toxicology and Mutagenesis ,030204 cardiovascular system & hematology ,Toxicology ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Epidemiology ,medicine ,Humans ,business.industry ,Infant, Newborn ,medicine.disease ,United States ,Pediatrics, Perinatology and Child Health ,Right heart ,Female ,Left heart disease ,business ,Regional differences ,Developmental Biology - Abstract
BACKGROUND Differences in the prevalence of left and right congenital heart defects (CHD) across the United States are unclear. This study evaluated the overall prevalence and the distribution of right versus left CHD across US regions and divisions in neonates. METHODS Newborns born from 2000 to 2014 diagnosed with CHD were identified using the National Inpatient Sample. Heart defects were stratified into right, left, and "neither" subtypes. The risk of right and left heart diagnoses between US Census regions and divisions was compared using multivariable binomial regression, adjusting for infant, and hospital characteristics. RESULTS Two hundred forty thousand four hundred fifty-five newborns were included and 38,185 (15.9%) were classifiable as having either right or left subtypes. Between 2000 and 2014, the prevalence of right defects increased from 1.65 to 2.88 cases/1,000 live born infants (p
- Published
- 2017
41. Feasibility of a healthcare system-based tetralogy of Fallot patient registry
- Author
-
Eric G. Jernigan, Jennifer S. Nelson, Audrey L. Khoury, Muntasir H. Chowdhury, and Laura R. Loehr
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,030225 pediatrics ,Epidemiology ,North Carolina ,medicine ,Humans ,Registries ,Retrospective Studies ,Tetralogy of Fallot ,Patient registry ,Descriptive statistics ,business.industry ,Incidence ,General Medicine ,Middle Aged ,medicine.disease ,Family medicine ,Pediatrics, Perinatology and Child Health ,Feasibility Studies ,Female ,Electronic data ,Diagnosis code ,Morbidity ,Outcomes research ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Follow-Up Studies ,Healthcare system - Abstract
BackgroundPatient-reported outcomes and epidemiological studies in adults with tetralogy of Fallot are lacking. Recruitment and longitudinal follow-up investigation across institutions is particularly challenging. Objectives of this study were to assess the feasibility of recruiting adult patients with tetralogy of Fallot for a patient-reported outcomes study, describe challenges for recruitment, and create an interactive, online tetralogy of Fallot registry.MethodsAdult patients living with tetralogy of Fallot, aged 18–58 years, at the University of North Carolina were identified using diagnosis code query. A survey was designed to collect demographics, symptoms, history, and birth mother information. Recruitment was attempted by phone (Part I, n=20) or by email (Part II, n=20). Data analysis included thematic grouping of recruitment challenges and descriptive statistics. Feasibility threshold was 75% for recruitment and for data fields completed per patient.ResultsIn Part I, 60% (12/20) were successfully contacted and eight (40%) were enrolled. Demographics and birth mother information were obtained for all enrolled patients. In Part II, 70% (14/20) were successfully contacted; 30% (6/20) enrolled and completed all data fields linked to REDCap database; the median time for survey completion was 8 minutes. Half of the patients had cardiac operations/procedures performed at more than one hospital. Automatic electronic data entry from the online survey was uncomplicated.ConclusionsAlthough recruitment (54%) fell below our feasibility threshold, enrolled individuals were willing to complete phone or online surveys. Incorrect contact information, privacy concerns, and patient-reported time constraints were challenges for recruitment. Creating an online survey and linked database is technically feasible and efficient for patient-reported outcomes research.
- Published
- 2017
42. Effect of Concomitant Birth Defects and Genetic Anomalies on Infant Mortality in Tetralogy of Fallot
- Author
-
Paula D. Strassle, Rebecca C. Stebbins, Eric G. Jernigan, Robert E. Meyer, and Jennifer S. Nelson
- Subjects
0301 basic medicine ,Embryology ,Pediatrics ,medicine.medical_specialty ,business.industry ,Health, Toxicology and Mutagenesis ,Odds ratio ,030204 cardiovascular system & hematology ,030105 genetics & heredity ,Toxicology ,medicine.disease ,Monitoring program ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Concomitant ,Pediatrics, Perinatology and Child Health ,Risk of mortality ,Medicine ,business ,Trisomy ,Survival analysis ,Developmental Biology ,Tetralogy of Fallot - Abstract
Background A substantial proportion of infants born with tetralogy of Fallot (TOF) die in infancy. A better understanding of the heterogeneity associated with TOF, including extracardiac malformations and chromosomal anomalies is vital to stratifying risk and optimizing outcomes during infancy. Methods Using the North Carolina Birth Defects Monitoring Program, infants diagnosed with TOF and born between 2003 and 2012 were included. Kaplan-Meier survival curves were used to estimate cumulative 1-year mortality, stratified by the presence of concomitant birth defects (BDs) and chromosomal anomalies. Multivariable logistic regression was used to estimate the direct effect of each concomitant BD, after adjusting for all others. Results A total of 496 infants with TOF were included, and 15% (n = 76) died. The number of concomitant BD systems was significantly associated with the risk of death at 1-year, p
- Published
- 2017
43. Geographic distribution of live births with tetralogy of Fallot in North Carolina 2003 to 2012
- Author
-
Robert E. Meyer, Rebecca C. Stebbins, Jennifer S. Nelson, and Paula D. Strassle
- Subjects
Embryology ,medicine.medical_specialty ,Spatial epidemiology ,Geographic variation ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Disease cluster ,Monitoring program ,Zip code ,Travel time ,Geographic distribution ,03 medical and health sciences ,0302 clinical medicine ,Geography ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Cardiology ,medicine ,030212 general & internal medicine ,Developmental Biology ,Tetralogy of Fallot ,Demography - Abstract
Background Geographic variation in congenital heart disease is not well-described. This study uses geographic information systems (GIS) to describe the spatial epidemiology of tetralogy of Fallot (TOF), in North Carolina (NC) and to compare travel time for cases to congenital heart centers in NC. Methods Using the NC Birth Defects Monitoring Program database, live births with TOF born between 2003 and 2012 were identified. Birth certificates provided demographic variables. A denominator of live births/zip code was obtained from the NC live births database. ArcGIS® software was used to illustrate TOF prevalence by zip code, and SatScanTM was used to identify spatial clusters of TOF cases and to identify changes in cluster location over time. Driving time to each of five NC congenital heart centers was predicted based on road systems information. Results A total of 496 infants were born with TOF between 2003 and 2012. The prevalence was 4.2/10,000 live births. A large cluster (330 zip codes, 306 cases) was identified in northeastern NC. Average driving time for each case to closest congenital heart center was: University of North Carolina 37 min, Vident Medical Center 64 min, Duke University 58 min, Carolina's Medical Center 89 min, and Wake Forest Baptist Health 57 min. Overall, average predicted driving time to the nearest congenital heart center was 61 min. Conclusion Approximately 50 infants/year were born with TOF in NC. One cluster was identified. Further study is necessary to explore potential explanations for the observed case cluster. As interest in regionalization of congenital heart surgery grows, GIS and spatial analysis can become increasingly useful tools for health care planning. Birth Defects Research (Part A) 106:881-887, 2016. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
44. Commentary: Allografts and pregnancy-Can good statistics lead to mis-conceptions about the relationship?
- Author
-
Jennifer S. Nelson
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pregnancy ,business.industry ,medicine.disease ,Allografts ,Lead (geology) ,Fertilization ,Medicine ,Humans ,Transplantation, Homologous ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2019
45. Cardiac venous malformation in a teenager
- Author
-
Peter D. Wearden, John T. Kennedy, and Jennifer S. Nelson
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Conservative management ,Adolescent ,Vascular Malformations ,Heart Ventricles ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Veins ,Hemangioma ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,business.industry ,General Medicine ,medicine.disease ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Radiology ,Approaches of management ,Cardiology and Cardiovascular Medicine ,Venous malformation ,business ,Echocardiography, Transesophageal - Abstract
We present the case of a 17-year-old boy with a cardiac venous malformation. This case highlights the diagnostic challenges of such tumours and demonstrates the potential efficacy of a watch-and-wait management approach.
- Published
- 2019
46. National Practice Patterns and Early Outcomes of Aortic Valve Replacement in Children and Teens
- Author
-
Peter D. Wearden, Jennifer S. Nelson, Sara K. Pasquali, Jennifer C. Romano, and Timothy M. Maul
- Subjects
Pulmonary and Respiratory Medicine ,Aortic valve ,Male ,Reoperation ,Pediatrics ,medicine.medical_specialty ,Adolescent ,MEDLINE ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Global Health ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Aortic valve replacement ,medicine ,Humans ,Practice Patterns, Physicians' ,Child ,Heart Valve Prosthesis Implantation ,Practice patterns ,business.industry ,Incidence (epidemiology) ,Incidence ,Infant ,Odds ratio ,medicine.disease ,Confidence interval ,Survival Rate ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Aortic Valve ,Child, Preschool ,Surgery ,Female ,Outcome data ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Several options exist for aortic valve replacement (AVR) in children and teens, but contemporary practice patterns and outcome data are lacking. We describe national AVR practice patterns and early outcomes.Children (aged 1 to 18 years) in The Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing AVR from 2000 to 2016 were included. Preoperative characteristics, operative data, and outcomes were described. To evaluate practice patterns, centers were assigned tertiles by aortic valve surgical volume. Statistical comparisons included Mann-Whitney U statistic, Kruskal-Wallis, χIn total, 3446 operations (46% children aged 1 to 12 years; 54% teens aged 12 to 18 years) were included. Preoperative risk factors were present in 23%, and 46% had a prior sternotomy. Valve utilization included autograft (64% child, 37% teen), mechanical (19% child, 35% teen), bioprosthetic (8% child, 20% teen), and homograft (9% child, 7% teen). Autografts were utilized more often for teenage girls than for teenage boys (odds ratio 1.3, 95% confidence interval: 1.05 to 1.66, P.05). Overall, inpatient mortality and major complications affected 1% and 10%, respectively, and these rates were highest for homografts (5%, P.001, and 13%, P.05). Autograft utilization varied widely across centers (10th to 90th percentile: 21% to 71% of total AVR volume). More autografts were utilized at high-volume centers vs low- or medium-volume centers (53% ± 2.3% vs 46% ± 2.6%, P.001).Practice patterns for AVR in children and teens vary across centers, age groups, and sexes. Although early outcomes were similar across valve types, homografts had higher morbidity and mortality. Valve choice was related to aortic valve surgical volume. Further efforts are needed to understand and optimize AVR practice patterns and long-term outcomes.
- Published
- 2019
47. Coarctation of the Aorta
- Author
-
James J. Gangemi, Matthew L. Stone, and Jennifer S. Nelson
- Subjects
Surgical repair ,Aorta ,medicine.medical_specialty ,Heart disease ,business.industry ,medicine.medical_treatment ,Coarctation of the aorta ,medicine.disease ,Hypoplasia ,Surgery ,medicine.artery ,Angioplasty ,Shock (circulatory) ,Concomitant ,medicine ,medicine.symptom ,business - Abstract
Coarctation of the aorta is a common form of congenital heart disease. Presentation, evaluation, and treatment of coarctation of the aorta is different in neonates and infants compared with older children. Neonates may present in shock and require prostaglandin E1 to maintain ductal patentcy until the time of surgical repair. Older children usually present with upper extremity hypertension or murmur. The approach to surgical repair of coarctation in neonates and infants depends on the presence or absence of concomitant defects and the degree of associated arch hypoplasia. For older children, robust collaterals and limited mobility of the aorta may mandate patch repair, interposition graft, or bypass of the coarctation segment. Percutaneous techniques, including angioplasty and stent placement, are often viable options for older children and adolescents with native or recurrent coarctation. Surgical and interventional outcomes have improved over time. Reliable repair may be anticipated with a very low rate of morbidity and mortality, although lifetime follow-up is recommended.
- Published
- 2019
48. Contributors
- Author
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Mubbasheer Ahmed, Samuel M. Alaish, Euleche Alanmanou, Plato Alexander, Alaa Aljiffry, Melvin C. Almodovar, Bahaaldin Alsoufi, Marc M. Anders, Nicholas D. Andersen, Judith Ascenzi, Scott I. Aydin, Matthew K. Bacon, David J. Barron, Amy Basken, Kimberly D. Beddows, Melania M. Bembea, Alexis L. Benscoter, Charles P. Bergstrom, Meghan Bernier, Steve Bibevski, David Bichell, Geoffrey L. Bird, Konstantinos Boukas, Edward L. Bove, Ken Brady, Craig S. Broberg, Ronald A. Bronicki, Julie A. Brothers, Kristen M. Brown, John R. Brownlee, Roosevelt Bryant, Amulya Buddhavarapu, Duke E. Cameron, Paul J. Chai, Paul A. Checchia, Ira M. Cheifetz, Clifford Chin, Jill Marie Cholette, Charles R. Cole, David S. Cooper, John D. Coulson, Ralph J. Damiano, Miguel DeLeon, Holly C. DeSena, Nina Deutsch, Pirooz Eghtesady, Branden Engorn, Allen Everett, Lloyd Felmly, Andrew C. Fiore, Gregory A. Fleming, Saul Flores, Rodney Franklin, Charles D. Fraser, Michael Gaies, James J. Gangemi, Lasya Gaur, Nancy S. Ghanayem, Salil Ginde, Katja M. Gist, Allan Goldman, Stuart L. Goldstein, Dheeraj Goswami, Eric M. Graham, Michelle A. Grenier, Stephanie S. Handler, James R. Herlong, Kevin D. Hill, Jennifer C. Romano, Siew Yen Ho, George M. Hoffman, Osami Honjo, Christoph P. Hornik, Daphne T. Hsu, Charles B. Huddleston, Christin Huff, Elizabeth A. Hunt, Salim F. Idriss, Ilias Iliopoulos, Kimberly Ward Jackson, Jeffrey P. Jacobs, Marshall L. Jacobs, James Jaggers, Laura N. Jansen, Christopher M. Janson, Robert Jaquiss, Emily Johnson, Melissa B. Jones, Lindsey Justice, Patricia L. Kane, Tara Karamlou, Vyas M. Kartha, Minoo N. Kavarana, Abigail May Khan, Valerie King, Roxanne E. Kirsch, Paul M. Kirshbom, Christopher J. Knott-Craig, Jeannie Koo, Jennifer Kramer, Catherine D. Krawczeski, Ganga Krishnamurthy, Sapna R. Kudchadkar, Karan R. Kumar, T.K. Susheel Kumar, David M. Kwiatkowski, Jacqueline M. Lamour, Timothy S. Lancaster, Benjamin J. Landis, Javier J. Lasa, Matthew H.L. Liava'a, Daniel J. Licht, Matthew T. Lisi, Ryan Loftin, Rohit S. Loomba, Bradley S. Marino, Thomas S. Maxey, Karen McCarthy, Michael C. McCrory, Inder D. Mehta, Christopher Mehta, Jon N. Meliones, Christine Meliones, Alison Miles, Michael E. Mitchell, Erica Molitor-Kirsch, Jenny A. Montgomery, Lisa Moore, David L.S. Morales, Cara Morin, Nicholas Morin, Steven S. Mou, Ashok Muralidaran, Raghav Murthy, Joseph R. Nellis, Jennifer S. Nelson, Kristen Nelson McMillan, Melanie Nies, John Nigro, Corina Noje, Sarah E. Norris, James O'Brien, George Ofori-Amanfo, Richard G. Ohye, Yoshio Ootaki, Caroline P. Ozment, Giles J. Peek, Autumn K. Peterson, Renuka E. Peterson, John K. Petty, Prashob Porayette, David E. Procaccini, James Quintessenza, William S. Ragalie, William Ravekes, Tia T. Raymond, Andrew Redington, Kyle J. Rehder, Becky Riggs, Ramon Julio Rivera, Jennifer Roark, Lewis H. Romer, Amy Ryan, Thomas D. Ryan, Beth A. Rymeski, Peter Sassalos, Jaclyn E. Sawyer, Frank Scholl, Kevin Patrick Schooler, Jennifer Schuette, Jamie McElrath, Daniel R. Sedehi, Priya Sekar, Donald H. Shaffner, Sanket Shah, Irving Shen, Avinash K. Shetty, Edd Shope, Darla Shores, Ming-Sing Si, Nida Siddiqi, Leah Simpson, Zdenek Slavik, Heidi A.B. Smith, Zebulon Z. Spector, Allison L. Speer, Philip Spevak, Dylan Stewart, Robert D. Stewart, James St. Louis, Matthew L. Stone, Erik Su, Kelly A. Swain, Cliff M. Takemoto, Sarah Tallent, Ravi R. Thiagarajan, Chani Traube, Ephraim Tropp, Rocky Tsang, Sebastian C. Tume, Joseph W. Turek, Jennifer L. Turi, Immanuel I. Turner, James S. Tweddell, Chinwe Unegbu, Ross M. Ungerleider, Jamie Dickey Ungerleider, Graham D. Ungerleider, Luca A. Vricella, Eric L. Vu, Rajeev S. Wadia, Michael J. Walsh, Kevin M. Watt, Karl Welke, Renée Willett, Derek A. Williams, Ronald K. Woods, Charlotte Woods-Hill, and Tharakanatha R. Yarrabolu
- Published
- 2019
49. Good News or Bad News? Considering Physician and Patient Perspectives on Outcomes
- Author
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Jennifer S. Nelson
- Subjects
Pulmonary and Respiratory Medicine ,Physician-Patient Relations ,Medical education ,business.industry ,Truth Disclosure ,Transplantation, Autologous ,Text mining ,Physicians ,Humans ,Medicine ,Surgery ,Autografts ,Child ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Published
- 2021
50. Visualizing Sacred History: Peter Dell's Resurrection and Lutheran Image Theology
- Author
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Jennifer S. Nelson
- Subjects
Cultural Studies ,General Arts and Humanities ,Philosophy ,Religious studies ,Theology - Abstract
In 1529, Peter Dell the Elder (1490–1552) made a relief sculpture of the Resurrection for Duke Heinrich of Saxony. At this time, Heinrich was shifting toward his wife Katharina's Lutheranism despite his elder brother Georg's disapproval. The relief's disjunctive, nonillusionistic appearance resonates with Lutheran image theology. Its maintenance of visual difference exemplifies a faith in sacred history's power to transcend historical difference; the relief depicts Heinrich's conversion as one sacrohistorical event among many. The relief's disjunctive appearance also provides an occasion to propose the general heuristic term “chimerism” to describe a specific kind of visual form: not a hybrid that fuses different visual modes, but a chimera that joins unlike features while preserving their differences.
- Published
- 2016
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