Publications by authors named "James E Davis"

24 Publications

  • Page 1 of 1

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Ann Surg 2020 08;272(2):e63-e65

Department of Surgery, Stony Brook Medicine, Stony Brook, New York.

Background: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients.

Methods: With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded.

Results: Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT.

Conclusion: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.
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http://dx.doi.org/10.1097/SLA.0000000000004031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268824PMC
August 2020

Augmenting an Inpatient Fall Program With Video Observation.

J Nurs Care Qual 2021 Jan-Mar 01;36(1):62-66

CarolinaEast Medical Center, New Bern, North Carolina (Dr Davis); and Capstone College of Nursing, The University of Alabama, Tuscaloosa (Dr Carter-Templeton).

Background: Keeping patients safe is a goal for all health care facilities. Facilities should look at technology as a way to help improve outcomes. Patient falls are a dangerous, costly, and preventable health care-associated event.

Local Problem: The fall rate on the host facility's orthopedic unit was 2.6 per 1000 patient-days.

Methods: Patients on an inpatient orthopedic unit who had a fall risk score greater than 13, based on the Johns Hopkins Fall Risk Assessment Tool, were provided with an added intervention, video observation.

Intervention: Video observation units with 2-way communication were introduced to help prevent patient falls.

Results: The fall rate per 1000 patient-days after implementing this intervention for 6 weeks was 0 falls per 1000 patient-days.

Conclusions: There was a 100% decrease in patient falls on the inpatient unit where video observation was implemented.
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http://dx.doi.org/10.1097/NCQ.0000000000000486DOI Listing
April 2020

Vitamin D-binding protein deficiency in mice decreases systemic and select tissue levels of inflammatory cytokines in a murine model of acute muscle injury.

J Trauma Acute Care Surg 2018 06;84(6):847-854

From the Department of Pathology (R.R.K., T.T., J.E.D.), Stony Brook University School of Medicine, Stony Brook, New York; and Division of Trauma, Department of Surgery (J.A.V., R.S.J.), Stony Brook University School of Medicine, Stony Brook, New York.

Background: Severe acute muscle injury results in massive cell damage, causing the release of actin into extracellular fluids where it complexes with the vitamin D-binding protein (DBP). We hypothesized that a systemic DBP deficiency would result in a less proinflammatory phenotype.

Methods: C57BL/6 wild-type (WT) and DBP-deficient (DBP-/-) mice received intramuscular injections of either 50% glycerol or phosphate-buffered saline into thigh muscles. Muscle injury was assessed by histology. Cytokine levels were measured in plasma, muscle, kidney, and lung.

Results: All animals survived the procedure, but glycerol injection in both strains of mice showed lysis of skeletal myocytes and inflammatory cell infiltrate. The muscle inflammatory cell infiltrate in DBP-deficient mice had remarkably few neutrophils as compared with WT mice. The neutrophil chemoattractant CXCL1 was significantly reduced in muscle tissue from DBP-/- mice. However, there were no other significant differences in muscle cytokine levels. In contrast, plasma obtained 48 hours after glycerol injection revealed that DBP-deficient mice had significantly lower levels of systemic cytokines interleukin 6, CCL2, CXCL1, and granulocyte colony-stimulating factor. Lung tissue from DBP-/- mice showed significantly decreased amounts of CCL2 and CXCL1 as compared with glycerol-treated WT mice. Several chemokines in kidney homogenates following glycerol-induced injury were significantly reduced in DBP-/- mice: CCL2, CCL5, CXCL1, and CXCL2.

Conclusions: Acute muscle injury triggered a systemic proinflammatory response as noted by elevated plasma cytokine levels. However, mice with a systemic DBP deficiency demonstrated a change in their cytokine profile 48 hours after muscle injury to a less proinflammatory phenotype.
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http://dx.doi.org/10.1097/TA.0000000000001875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970036PMC
June 2018

Neutrophil Phenotype Correlates With Postoperative Inflammatory Outcomes in Infants Undergoing Cardiopulmonary Bypass.

Pediatr Crit Care Med 2017 Dec;18(12):1145-1152

Department of Pediatrics, University of Iowa Hospitals and Clinics University of Iowa Children's Hospital, Iowa City, IA.

Objectives: Infants with congenital heart disease frequently require cardiopulmonary bypass, which causes systemic inflammation. The goal of this study was to determine if neutrophil phenotype and activation status predicts the development of inflammatory complications following cardiopulmonary bypass.

Design: Prospective cohort study.

Setting: Tertiary care PICU with postoperative cardiac care.

Patients: Thirty-seven patients 5 days to 10 months old with congenital heart disease requiring cardiopulmonary bypass.

Interventions: None.

Measurements And Main Results: Laboratory and clinical data collected included length of mechanical ventilation, acute kidney injury, and fluid overload. Neutrophils were isolated from whole blood at three time points surrounding cardiopulmonary bypass. Functional analyses included measurement of cell surface protein expression and nicotinamide adenine dinucleotide phosphate oxidase activity. Of all patients studied, 40.5% displayed priming of nicotinamide adenine dinucleotide phosphate oxidase activity in response to N-formyl-Met-Leu-Phe stimulation 24 hours post cardiopulmonary bypass as compared to pre bypass. Neonates who received steroids prior to bypass demonstrated enhanced priming of nicotinamide adenine dinucleotide phosphate oxidase activity at 48 hours. Patients who displayed priming post cardiopulmonary bypass were 8.8 times more likely to develop severe acute kidney injury as compared to nonprimers. Up-regulation of neutrophil surface CD11b levels pre- to postbypass occurred in 51.4% of patients, but this measure of neutrophil priming was not associated with acute kidney injury. Subsequent analyses of the basal neutrophil phenotype revealed that those with higher basal CD11b expression were significantly less likely to develop acute kidney injury.

Conclusions: Neutrophil priming occurs in a subset of infants undergoing cardiopulmonary bypass. Acute kidney injury was more frequent in those patients who displayed priming of nicotinamide adenine dinucleotide phosphate oxidase activity after cardiopulmonary bypass. This pilot study suggests that neutrophil phenotypic signature could be used to predict inflammatory organ dysfunction.
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http://dx.doi.org/10.1097/PCC.0000000000001361DOI Listing
December 2017

The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System.

Prehosp Disaster Med 2017 Apr 18;32(2):175-179. Epub 2017 Jan 18.

1City of Columbus,Division of Fire,Columbus,OhioUSA.

Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).

Methods: This was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (P<.05).

Results: Median on-scene times at Station A for the PP ambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates.

Conclusion: In the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in time to ALS interventions and protocol violation rates were not different. Hybrid ambulance teams may be an effective staffing alternative, but decisions to use this model must address clinical and operational concerns. Cortez EJ , Panchal AR , Davis JE , Keseg DP . The effect of ambulance staffing models in a metropolitan, fire-based EMS system. Prehosp Disaster Med. 2017;32(2):175-179.
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http://dx.doi.org/10.1017/S1049023X16001539DOI Listing
April 2017

Patch-based Convolutional Neural Network for Whole Slide Tissue Image Classification.

Proc IEEE Comput Soc Conf Comput Vis Pattern Recognit 2016 Jun-Jul;2016:2424-2433

Dept. of Computer Science, Stony Brook University; Dept. of Biomedical Informatics, Stony Brook University; Dept. of Pathology, Stony Brook Hospital; Cancer Center, Stony Brook Hospital.

Convolutional Neural Networks (CNN) are state-of-the-art models for many image classification tasks. However, to recognize cancer subtypes automatically, training a CNN on gigapixel resolution Whole Slide Tissue Images (WSI) is currently computationally impossible. The differentiation of cancer subtypes is based on cellular-level visual features observed on image patch scale. Therefore, we argue that in this situation, training a patch-level classifier on image patches will perform better than or similar to an image-level classifier. The challenge becomes how to intelligently combine patch-level classification results and model the fact that not all patches will be discriminative. We propose to train a decision fusion model to aggregate patch-level predictions given by patch-level CNNs, which to the best of our knowledge has not been shown before. Furthermore, we formulate a novel Expectation-Maximization (EM) based method that automatically locates discriminative patches robustly by utilizing the spatial relationships of patches. We apply our method to the classification of glioma and non-small-cell lung carcinoma cases into subtypes. The classification accuracy of our method is similar to the inter-observer agreement between pathologists. Although it is impossible to train CNNs on WSIs, we experimentally demonstrate using a comparable non-cancer dataset of smaller images that a patch-based CNN can outperform an image-based CNN.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5085270PMC
http://dx.doi.org/10.1109/CVPR.2016.266DOI Listing
November 2016

Metachronous Malignant Solitary Fibrous Tumor of Kidney: Case Report and Review of Literature.

Urol Case Rep 2016 Jan 17;4:45-7. Epub 2015 Oct 17.

Department of Urology, Winthrop University Hospital, 1501 Franklin Avenue, Garden City, NY 11530, USA.

Solitary fibrous tumors are well described in the pleura, but rare extra-pleural neoplasms have been reported. We describe a patient with a solitary left renal fibrous tumor who after undergoing a nephrectomy, presented 8 years later with a contralateral metachronous solitary fibrous tumor. Malignant metastatic extra-pleural solitary fibrous tumors are extremely rare, and to our knowledge, this is the first case of contralateral recurrence of solitary renal fibrous tumor. The patient underwent a robotic assisted partial nephrectomy of the right renal mass. Both tumors showed overlapping histopathology.
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http://dx.doi.org/10.1016/j.eucr.2015.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719796PMC
January 2016

Optic Nerve Sheath Melanoma Presenting as a Central Retinal Vein Occlusion.

J Neuroophthalmol 2016 Mar;36(1):70-2

Department of Ophthalmology (AB, PS, NB), Pathology (JED), and School of Medicine (NS), State University of New York at Stony Brook, Stony Brook, New York.

A 64-year-old woman, with a history of diabetes and melanoma, developed a central retinal vein occlusion (CRVO) in her left eye. On exam, she had severe disc edema with retinal nerve fiber layer thickening, and anterior deformation of the peripapillary retinal pigment epithelium (RPE)/Bruch membrane layer (ppRPE/BM) toward the vitreous on spectral domain optical coherence tomography (SD-OCT) suggesting an optic nerve sheath (ONS) meningioma. Magnetic resonance imaging findings and ONS biopsy later confirmed a metastatic melanoma. This case demonstrates that the shape of the RPE/BM on SD-OCT may aid in the decision to consider imaging in patients with isolated CRVO.
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http://dx.doi.org/10.1097/WNO.0000000000000310DOI Listing
March 2016

Her2 and Ki67 Biomarkers Predict Recurrence of Ductal Carcinoma in Situ.

Appl Immunohistochem Mol Morphol 2016 Jan;24(1):20-5

Department of Pathology, Stony Brook University Hospital, Stony Brook University School of Medicine, Stony Brook, NY.

Background: A subset of patients with ductal carcinoma in situ (DCIS) experience recurrence or progression to invasive cancer. Current clinical practice is not reliably guided by DCIS recurrence prediction, although recurrence risk for invasive breast cancer can now be assessed. We analyzed a panel of biomarkers (estrogen receptor, Her2, Ki67, p53, cyclin D1, COX-2, caveolin-1, survivin, and PPAR-γ) and DCIS histologic and clinical features to determine associations with DCIS recurrence.

Materials And Methods: Seventy DCIS cases diagnosed between 1995 and 2010 were divided into 2 groups: 52 had DCIS without known recurrence after excision and 18 had DCIS with subsequent recurrence after excision as DCIS or invasive carcinoma in the ipsilateral or contralateral breast. Tissue microarrays were prepared, immunohistochemistry performed, and expression of the biomarkers scored semiquantitatively. Variables analyzed included age, tumor size, margin status, DCIS grade, necrosis, histologic type, and immunohistochemistry scores. Differences between groups were evaluated using t tests for continuous variables and Fisher exact tests for categorical variables.

Results: Intraductal necrosis was associated with increased recurrence risk: 46% of nonrecurrent cases showed necrosis compared with 83% of those who recurred (P=0.007). Her2 (human epidermal growth factor receptor 2) and Ki67 expression distributions were significantly different between nonrecurrent and recurrent cases. Her2 was overexpressed in 14% of nonrecurrent cases compared with 50% in the recurrent cases (P=0.03). A total of 87% of nonrecurrent cases had low Ki67 staining (0% to 10%) compared with 50% among the recurrent cases (P=0.002).

Conclusion: Our results suggest that Her2 and Ki67 immunohistochemistry and the presence of intraductal necrosis aid in DCIS risk stratification.
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http://dx.doi.org/10.1097/PAI.0000000000000223DOI Listing
January 2016

The correction index: setting the standard for recommending operative repair of pectus excavatum.

Ann Thorac Surg 2014 Apr 26;97(4):1176-9; discussion 1179-80. Epub 2014 Feb 26.

Division of Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics and University of Iowa Children's Hospital, Iowa City, Iowa. Electronic address:

Background: The Haller index, derived from a chest computed tomography scan, remains the standard for determining candidacy for pectus excavatum repair (Haller index≥3.25). However, it has been suggested that this index may not accurately reflect pectus severity in patients with abnormal chest wall morphologies. This study explores a new, more appropriate criteria for recommending repair based on a correction index, while still incorporating the standard set by the Haller index.

Methods: A database of 75 patients with pectus excavatum who received computed tomography scans was compiled. For each patient, a staff radiologist calculated the Haller index, a correction index, and an ideal chest index from the computed tomography image with the greatest sternal depression. A correlation was assessed between all Haller and correction indices and separately for those with standard and nonstandard chest dimensions as assessed by an ideal chest index.

Results: There was a modest correlation between the Haller and correction indices measured in this cohort (r=0.79; p<0.0001). When patients with aberrant ideal chest dimensions were removed from analysis, Haller and correction indices showed a stronger correlation (r=0.86; p<0.0001).

Conclusions: The correction index provides an accurate assessment of pectus severity, and by the nature of the measurement, reflects the potential degree of operative repair. The Haller index correlates well with the correction index in pectus patients with standard chest wall dimensions, but is quite discrepant in the nonstandard chest. We recommend operative repair for pectus excavatum with a correction index of 28% or more, because this value correlates with the long-accepted standard (Haller index≥3.25) and this index remains accurate even in nonstandard chest morphologies.
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http://dx.doi.org/10.1016/j.athoracsur.2013.12.050DOI Listing
April 2014

Defining the role of chest radiography in determining candidacy for pectus excavatum repair.

Innovations (Phila) 2014 Mar-Apr;9(2):117-21; discussion 121

From the Divisions of *Pediatric Cardiac Surgery, †Pediatric Cardiology, and ‡Radiology, University of Iowa Hospitals and Clinics and University of Iowa Children's Hospital, Iowa City, IA USA.

Objective: The Haller index (HI), derived from computed tomography (CT) of the chest, remains the standard for determining pectus excavatum (PE) severity. The ability to accurately determine PE severity from chest radiography (CXR) may provide substantial benefits. This study proposes to establish data-driven criteria for the use of CXR as a diagnostic modality in the preoperative evaluation of patients with PE.

Methods: A database of 77 patients with PE receiving preoperative CXR and CT was created. Haller indices were obtained from CT scans. Two cardiothoracic surgeons, blinded to the CT HI scores, independently calculated CXR HIs. Interrater reliability, correlations, sensitivity, specificity, and accuracy were calculated.

Results: A significant correlation was found between CXR HI estimates of the two observers, r = 0.84. Computed tomography HIs were used as the standard for identifying patients meeting surgical criteria (CT HI ≥3.2). From this, sensitivities, specificities, and accuracies were calculated for the corresponding CXR HIs determined by each observer. Observer CXR HI estimates had a sensitivity of 0.94 and 0.92, specificity of 0.77 and 0.42, and accuracy of 0.88 and 0.75.

Conclusions: We found a strong correlation between HIs calculated with each modality. In addition, CXR HIs demonstrated good interrater reliability. Although the sensitivity of CXR in diagnosing severe PE (CT HI ≥3.2) was high, specificity was less convincing. However, when using a cutoff of CXR HIs of 3.75 or greater, combined specificity was quite high (0.96). We recommend replacing CT with CXR in the preoperative evaluation for PE. Computed tomography should be used as a confirmatory test for CXR HIs between 3.2 and 3.75.
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http://dx.doi.org/10.1097/IMI.0000000000000048DOI Listing
January 2015

Semiautologous repair for congenital discontinuous right pulmonary artery.

Ann Thorac Surg 2013 Dec;96(6):2230-1

Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Unilateral absence of a proximal pulmonary artery (UAPA) is rare and occurs in an isolated form or in the presence of other cardiovascular anomalies. There is a paucity of literature describing surgical correction of this anomaly. Most commonly, a primary anastomosis between the main and proximal right pulmonary arteries has been described. However, in cases of long-gap discontinuity, this can be difficult and may result in excess tension on the anastomosis, predisposing to decreased patency. We present a novel technique by which discontinuity in the right pulmonary artery (RPA) is surgically corrected in a semiautologous fashion using a main pulmonary artery (MPA) flap.
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http://dx.doi.org/10.1016/j.athoracsur.2013.02.057DOI Listing
December 2013

Norwood reconstruction using continuous coronary perfusion: a safe and translatable technique.

Ann Thorac Surg 2013 Jul 11;96(1):219-23: discussion 223-4. Epub 2013 May 11.

Division of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, Iowa 52242-1062, USA.

Background: Continuous coronary perfusion during Norwood reconstruction offers the theoretic advantage of less postoperative cardiac dysfunction. The avoidance of a cardiac and circulatory arrest period allows time for a more deliberate aortic reconstruction while the heart remains beating. This single-center study was designed to compare patient results using this method vs standard cardiac arrest for Norwood reconstruction.

Methods: A retrospective review was done of 32 patients undergoing Norwood reconstruction from November 2004 to July 2011. The operations in the most recent 16 consecutive patients were performed under deep hypothermia with constant coronary and cerebral perfusion. Continuous coronary perfusion was provided by a cannula inserted into the proximal aorta. The operations in the prior 16 consecutive patients were performed using deep hypothermia, selective cerebral perfusion, and cardioplegic arrest during aortic reconstruction.

Results: Survival in the beating-heart group was 87.5% (14 of 16) vs 62.5% (10 of 16) in the standard group (p = 0.22). No patients in the beating-heart group required extracorporeal membrane oxygenation vs 3 in the standard group. Postoperative cardiac function was similar for both groups. The beating-heart cohort had lower peak lactate levels (8.2 mEq/L) than the standard group (10.7 mEq/L, p = 0.022).

Conclusions: This study presents the largest series of Norwood operations in which the entire aorta is augmented while delivering continuous coronary perfusion. The technique is applicable to any size aorta and represents a safe alternative because outcomes for survival, freedom from extracorporeal membrane oxygenation, postoperative cardiac function, and lactate levels were all noninferior compared with the standard technique.
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http://dx.doi.org/10.1016/j.athoracsur.2013.03.049DOI Listing
July 2013

Illusion of stroke: intravascular lymphomatosis.

Rev Neurol Dis 2011 ;8(3-4):e107-13

Department of Neurology, Harvard Medical School, Boston, MA, USA.

We describe an unusual case of cerebral intravascular lymphomatosis wherein the patient presented with multiple embolic strokes predominantly in the posterior circulation. Using this case as an illustration, we review the literature of this malignancy, which consists of extranodal diffuse large B-cell lymphoma. For patients with recurrent stroke-like events without cardiac risk factors, the accurate diagnosis requires a high index of suspicion by the neurologist and a brain biopsy specimen demonstrating lymphoma cells within the lumen of cerebral blood vessels. Intravascular lymphomatosis can be treated with systemic chemotherapies, but the response rate and pattern of relapse remain unknown.
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October 2012

71-year-old female with right eye proptosis.

Brain Pathol 2011 Nov;21(6):709-10

Meningiomas that arise outside the cranial vault without a dural connection comprise about 1–2% of all meningiomas and are referred to as primary extradural meningiomas (PEMs), intraosseous type 1. When these tumors occur within bone, they may be initially misinterpreted radiologically as a primary bone lesion.We report the case of a 71-year-old woman found to have a right lateral orbital wall mass without dural involvement. Pathology confirmed a PEM and we review the clinical, radiologic, and pathologic features of this case.
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http://dx.doi.org/10.1111/j.1750-3639.2011.00529.xDOI Listing
November 2011

The impact of prolonged rotary ventricular assist device support upon ventricular geometry and flow kinetics.

J Am Soc Echocardiogr 2011 Feb 18;24(2):149-56. Epub 2010 Nov 18.

Carver College of Medicine, University of Iowa, Iowa City, IA, USA.

Background: The aim of this study was to determine the impact of prolonged left ventricular assist device (VAD) support on cardiac ventricular geometry and VAD flow kinetics.

Methods: Nineteen patients with end-stage heart failure underwent the implantation of HeartMate II rotary flow VADs. Left and right ventricular geometry and VAD flow kinetics were assessed by transthoracic echocardiography early (7 ± 1 days) and late (113 ± 21 days) after VAD implantation.

Results: Left ventricular end-diastolic internal dimension decreased by 21% and 35%, respectively, early and late after VAD implantation (n = 19; P < .001 vs before VAD implantation). Right ventricular end-diastolic internal dimension did not decrease at either time. Hemodynamic trends were similar. VAD inflow obstruction by myocardium was observed in eight patients, seven of whom demonstrated significantly increased variation of VAD inflow during the cardiac cycle ("pulsatility") detected by Doppler studies. Medical or surgical intervention returned VAD flow patterns toward baseline in seven of eight patients with VAD obstructions.

Conclusions: Prolonged rotary VAD support unloads the left ventricle, with modest effects on the right ventricle. These changes are often associated with alterations of VAD flow kinetics, requiring therapeutic intervention. These findings indicate the usefulness of echocardiographic surveillance in patients undergoing prolonged VAD support.
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http://dx.doi.org/10.1016/j.echo.2010.10.009DOI Listing
February 2011

Reliability Fusion of Time-of-Flight Depth and Stereo Geometry for High Quality Depth Maps.

IEEE Trans Pattern Anal Mach Intell 2011 Jul 9;33(7):1400-14. Epub 2010 Sep 9.

Time-of-flight range sensors have error characteristics, which are complementary to passive stereo. They provide real-time depth estimates in conditions where passive stereo does not work well, such as on white walls. In contrast, these sensors are noisy and often perform poorly on the textured scenes where stereo excels. We explore their complementary characteristics and introduce a method for combining the results from both methods that achieve better accuracy than either alone. In our fusion framework, the depth probability distribution functions from each of these sensor modalities are formulated and optimized. Robust and adaptive fusion is built on a pixel-wise reliability weighting function calculated for each method. In addition, since time-of-flight devices have primarily been used as individual sensors, they are typically poorly calibrated. We introduce a method that substantially improves upon the manufacturer's calibration. We demonstrate that our proposed techniques lead to improved accuracy and robustness on an extensive set of experimental results.
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http://dx.doi.org/10.1109/TPAMI.2010.172DOI Listing
July 2011

An option for intraoperative placement of an intra-aortic balloon pump in patients with occlusive peripheral vascular disease.

J Thorac Cardiovasc Surg 2011 Feb 14;141(2):586-7. Epub 2010 Jul 14.

Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.

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http://dx.doi.org/10.1016/j.jtcvs.2010.06.021DOI Listing
February 2011

Can private, non-university-affiliated cardiothoracic training programs provide sufficient surgical experience in cardiac tumors?

J Surg Educ 2009 Jul-Aug;66(4):190-2

Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.

Surgical case volumes in non-university-affiliated cardiothoracic surgery training programs in the US have been extensively studied by the Residency Review Committee (RRC) for thoracic surgery. The RRC has established that these programs offer a broad experience in common cardiothoracic procedures such as myocardial revascularization, valvular surgery, and cardiopulmonary transplantation. However, resident exposure to other important but less common cardiac surgical conditions in these programs remains unanswered. To address this question, an institutional review board-approved retrospective review of the experience of thoracic surgery residents with one of the rarest of surgical conditions, cardiac tumors, was conducted at the Ochsner Clinic Foundation in New Orleans, Louisiana. A survey of existing private, non-university-affiliated US cardiothoracic surgery training programs was conducted to determine the extent of the cardiac tumor experience in these programs. The results were then compared with selected university programs.
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http://dx.doi.org/10.1016/j.jsurg.2009.06.006DOI Listing
January 2010

Quality of care for older adults with chronic obstructive pulmonary disease and asthma based on comparisons to practice guidelines and smoking status.

BMC Health Serv Res 2008 Jul 8;8:144. Epub 2008 Jul 8.

Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA.

Background: The purpose of this study was to describe the prevalence of respiratory diseases in older adults and compare the demographic, health and smoking characteristics of those with and without these diseases. Furthermore, we evaluate the association between smoking status and patterns in health care and how concordant this care is with guidelines.

Methods: Using a nationally representative sample of 29,902 older adults who participated in the Medicare Current Beneficiary Survey (1992-2002), we compared guideline recommendations on the treatment and prevention of chronic obstructive pulmonary disease and asthma with survey utilization data, including the use of bronchodilators, spirometry and influenza vaccine.

Results: 26% to 30% of older adults were diagnosed with or self-reported chronic respiratory diseases; however 69% received no pharmacological treatment and 30% of patients reporting use of pharmacological treatments did not receive short-acting bronchodilator inhalers. Current smokers appeared to receive significantly less care for respiratory diseases than non-smokers or former smokers.

Conclusion: Disparities between recommended and actual care for older adults with chronic lung disease require further research. The needs of older adults with co-morbidities and nicotine addiction deserve special attention in care as well as guideline development and implementation.
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http://dx.doi.org/10.1186/1472-6963-8-144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2500012PMC
July 2008

BRDF invariant stereo using light transport constancy.

IEEE Trans Pattern Anal Mach Intell 2007 Sep;29(9):1616-26

Department of Computer Science, University of Louisville, Louisville, KY 40507, USA.

Nearly all existing methods for stereo reconstruction assume that scene reflectance is Lambertian and make use of brightness constancy as a matching invariant. We introduce a new invariant for stereo reconstruction called light transport constancy (LTC), which allows completely arbitrary scene reflectance (bidirectional reflectance distribution functions (BRDFs)). This invariant can be used to formulate a rank constraint on multiview stereo matching when the scene is observed by several lighting configurations in which only the lighting intensity varies. In addition, we show that this multiview constraint can be used with as few as two cameras and two lighting configurations. Unlike previous methods for BRDF invariant stereo, LTC does not require precisely configured or calibrated light sources or calibration objects in the scene. Importantly, the new constraint can be used to provide BRDF invariance to any existing stereo method whenever appropriate lighting variation is available.
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http://dx.doi.org/10.1109/TPAMI.2007.1171DOI Listing
September 2007

Minimally invasive implantation of a cardioverter-defibrillator in a small patient.

J Thorac Cardiovasc Surg 2007 May;133(5):1375-6

Division of Pediatric Cardiology, the Ochsner Clinic Foundation, New Orleans, LA 70121, USA.

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http://dx.doi.org/10.1016/j.jtcvs.2007.01.042DOI Listing
May 2007

Cancer prevention services and physician consensus in primary care group practices.

Cancer Epidemiol Biomarkers Prev 2004 Jun;13(6):958-66

Department of Family Medicine and Practice, School of Medicine, University of Wisconsin, Madison, WI 53726-2397, USA.

Background: We conducted a randomized clinical trial of interventions to achieve physician consensus, practice changes, and patient activation designed to help primary care group practices enhance the delivery of cancer prevention and screening services.

Methods: In each of 42 primary care practices in 1991 to 1994, we studied approximately 60 patients per physician who were between the ages 53 and 64. Data sources included patient and physician questionnaires, medical record audits of consenting patients for evidence of 11 cancer prevention services during the previous 3 years, and telephone interviews with key practice personnel.

Results: None of the interventions was associated with significant changes in frequency of services or procedures received or provided. Increased frequencies of services overall and of specific activities were associated with HMO membership or insurance coverage for six screening procedures. Patient reports of clinic staff recommendations to have each of six screening procedures were specifically associated with higher frequencies of services (P = 0.001).

Conclusions: Demonstration of intervention impact may have been limited because the rates of prevention services were significantly higher in this study than have been reported elsewhere. These results might be explained by selection biases inherent in studying patients with a regular provider, overall practice trends for changes in provision of the studied services, and the study methods.
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June 2004

Revascularization in severe ventricular dysfunction (15% < OR = LVEF < OR = 30%): a comparison of bypass grafting and percutaneous intervention.

Ann Thorac Surg 2002 Dec;74(6):2082-7; discussion 2087

Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana 07121, USA.

Background: We sought to determine the optimal approach to revascularization of patients with severe left ventricular (LV) dysfunction.

Methods: We conducted a single-center observational study of 117 consecutive patients who had severe LV dysfunction (15% < OR = LV ejection fraction < OR = 30%) and underwent either coronary artery bypass grafting (CABG, n = 69) or percutaneous revascularization (n = 48) between 1992 and 1997.

Results: The CABG group was younger (62 versus 67 years, p = 0.026), and fewer previous bypasses (7% versus 40%, p < 0.0001) and fewer prior percutaneous revascularizations (16% versus 42%, p = 0.0019) were noted. More vessels were revascularized (3 +/- 0.8 versus 1.5 +/- 0.7, p < 0.0001), and revascularization was more complete by CABG (84% versus 48%, p < 0.0001). Morbidity and mortality at 30 days were similar, and there was no significant difference in 3-year survival (73% versus 67%), although 3-year cardiac event-free survival (52% versus 25%, p = 0.0011) and 3-year target vessel revascularization-free survival (71% versus 41%, p < 0.0001) were significantly better in the CABG group, and LV ejection fraction was significantly improved after CABG. In the subgroup of patients 65 years of age or older and those without proximal left anterior descending coronary artery lesions, significant benefit of CABG in cardiac event-free and target vessel revascularization-free survival disappeared.

Conclusions: We found that in clinically selected patients with severe ventricular dysfunction, CABG compared with percutaneous revascularization achieves more complete revascularization, improved LV function, fewer cardiac events, and fewer target vessel revascularizations, but does not affect mid-term survival. A prospective controlled trial with defined criteria for treatment assignment is warranted to confirm our results regarding the two revascularization strategies in patients with severe LV dysfunction.
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http://dx.doi.org/10.1016/s0003-4975(02)04120-6DOI Listing
December 2002