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Berlin Brandenburg

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  • 1
    Language: English
    In: Annals of Pharmacotherapy, 10/1998, Vol.32(10), pp.1020-1023
    Description: OBJECTIVE: To report successful desensitization in a patient with a history of end-stage renal disease (ESRD) and anaphylactic shock after receiving vancomycin. CASE SUMMARY: A 47-year-old white woman with a history of ESRD was admitted to the hospital reporting persistent nausea, vomiting, and diffuse abdominal pain. She had developed anaphylactic shock after exposure to vancomycin 3 years prior to this hospitalization. The patient's hospital course was complicated by septic shock and positive blood cultures for methicillin-resistant Staphylococcus epidermidis . The patient tolerated vancomycin desensitization and received intravenous vancomycin 100 mg/d for 21 days. DISCUSSION: The desensitization protocol used in this report allows for gradual increases in vancomycin serum concentrations, avoiding peak and trough concentrations that occur with intravenous boluses. Maintaining the desensitized state is dependent on the continuous presence of the antigen with a return of clinical sensitivity after drug discontinuation. The vancomycin desensitization protocol and subsequent dosing strategy was used to ensure the continuous presence of vancomycin at steady-state concentrations to prevent the return of anaphylactic sensitivity. CONCLUSIONS: Desensitization was successful in a patient with ESRD and history of anaphylactic shock to vancomycin.
    Keywords: Vancomycin ; Desensitization;
    ISSN: 1060-0280
    E-ISSN: 1542-6270
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  • 2
    Language: English
    In: Gastroenterology, May 2013, Vol.144(5), pp.S-733-S-733
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    In: The New England Journal of Medicine, 2016, Vol.375(24), pp.2395-2400
    Description: Federal health agency leaders describe plans to develop infrastructure for generating high-quality evidence to improve care. They argue that it will be necessary to embed research in clinical care, create interoperable research data networks, and apply new research methods. Making better choices about health and health care requires the best possible evidence. Unfortunately, many of the decisions made today in our health care system are not supported by high-quality evidence 1 – 4 derived from randomized, controlled trials or well-designed observational studies. But as rich, diverse sources of digital data become widely available for research and as analytical tools continue to grow in power and sophistication, the research and health care communities now have the opportunity to quickly and efficiently generate the scientific evidence needed to support improved decision making about health and health care. The pursuit of high-quality, data-driven evidence . . .
    Keywords: Medicine;
    ISSN: 0028-4793
    E-ISSN: 1533-4406
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  • 4
    In: The Journal of Infectious Diseases, 2018, Vol. 218(4), pp.633-644
    Description: The genetic diversity of human immunodeficiency virus type 1 (HIV-1) is a significant challenge to developing a prophylactic vaccine. One strategy to increase cellular immune responses is the use of computationally derived mosaic immunogens. In this first-in-human assessment, multiclade HIV-1–specific immune responses were elicited.
    Keywords: Hiv Vaccine ; Mosaic Immunogens ; Safety ; Immunogenicity ; Modified Vaccinia Ankara
    ISSN: 0022-1899
    E-ISSN: 1537-6613
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  • 5
    Language: English
    In: Studies in health technology and informatics, 2013, Vol.184, pp.261-7
    Description: In the context of image-guided left atrial fibrillation therapy, relatively very little work has been done to consider the changes that occur in the tissue during ablation in order to monitor therapy delivery. Here we describe a technique to predict the lesion progression and monitor the radio-frequency energy delivery via a thermal ablation model that uses heat transfer principles to estimate the tissue temperature distribution and resulting lesion. A preliminary evaluation of the model was conducted in ex vivo skeletal beef muscle tissue while emulating a clinically relevant tissue ablation protocol. The predicted temperature distribution within the tissue was assessed against that measured directly using fiberoptic temperature probes and showed agreement within 5°C between the model-predicted and experimentally measured tissue temperatures at prescribed locations. We believe this technique is capable of providing reasonably accurate representations of the tissue response to radio-frequency energy delivery.
    Keywords: Models, Cardiovascular ; User-Computer Interface ; Atrial Fibrillation -- Surgery ; Catheter Ablation -- Methods ; Surgery, Computer-Assisted -- Methods
    ISSN: 0926-9630
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    Language: English
    In: Gastroenterology, 2009, Vol.136(5), pp.A-784-A-784
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
    Source: ScienceDirect Journals (Elsevier)
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  • 7
    Language: English
    In: Journal of Surgical Research, 2010, Vol.161(1), pp.23-27
    Description: Simulators for surgical education are in high demand due to new curriculum requirements for surgical residency accreditation. Our aim was to assess the usability and perceived effectiveness of a three-dimensional (3-D) pelvic anatomy teaching module derived from human magnetic resonance and computerized tomography images. A convenience sample of medical students and surgery residents was surveyed. Results are frequency (proportion) of respondents who agreed or strongly agreed with each statement. Ten participants (5 medical students, 5 surgical residents) completed the survey. At baseline, a minority (30%) self-reported a very good knowledge of pelvic anatomy; none reported excellent knowledge of pelvic anatomy. All participants agreed that the module teaches clinically relevant anatomy; 90% preferred this type of education to traditional methods. Fifty percent of participants felt the module needed a higher level of anatomic detail. Participants specifically requested inclusion of Denonvillier's and Waldeyer's fascia, and the component muscles of the pelvic floor. These pilot results suggest that our 3-D pelvic anatomy teaching module is easy to use and would enhance student learning of anatomy over traditional methods in an effective manner. Further study is warranted to assess the incremental impact of this and standard educational interventions for teaching surgical anatomy.
    Keywords: Virtual Anatomy ; Simulation ; Pelvis ; Surgery
    ISSN: 0022-4804
    E-ISSN: 1095-8673
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  • 8
    In: Medical Physics, February 2014, Vol.41(2), pp.n/a-n/a
    Description: Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy.
    Keywords: Radiography ; Ultrasonography ; Registration ; Monte Carlo Simulations ; Distribution Theory And Monte Carlo Studies ; Biological Tissues ; Biomedical Ultrasonics ; Cardiology ; Catheters ; Diagnostic Radiography ; Image Registration ; Medical Image Processing ; Monte Carlo Methods ; Phantoms ; Left Atrium ; Cardiac Ablation ; Atrial Fibrillation ; Image‐Guided Interventions ; Registration ; Diagnosis Using Ultrasonic ; Sonic Or Infrasonic Waves ; Catheters; Hollow Probes ; Biological Material ; E.G. Blood ; Urine; Haemocytometers ; Digital Computing Or Data Processing Equipment Or Methods ; Specially Adapted For Specific Applications ; Image Data Processing Or Generation ; In General ; Medical Imaging ; Heart ; Computed Tomography ; Ultrasonography ; Monte Carlo Methods ; Cardiac Dynamics ; Medical Image Noise ; Stellar Spectral Lines ; Fluoroscopy ; Anatomy
    ISSN: 0094-2405
    E-ISSN: 2473-4209
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  • 9
    Language: English
    In: 18 March 2015, Vol.9415, pp.941506-941506-8
    Description: Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrodetissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel[1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.
    ISBN: 9781628415056
    ISBN: 1628415053
    ISSN: 0277786X
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  • 10
    Language: English
    In: Journal of Bone and Mineral Research, September 2010, Vol.25(9), pp.1922-1930
    Description: Because they are not reliably discriminated by areal bone mineral density (aBMD) measurements, it is unclear whether minimal vertebral deformities represent early osteoporotic fractures. To address this, we compared 90 postmenopausal women with no deformity (controls) with 142 women with one or more semiquantitative grade 1 (mild) deformities and 51 women with any grade 2–3 (moderate/severe) deformities. aBMD was measured by dual‐energy X‐ray absorptiometry (DXA), lumbar spine volumetric bone mineral density (vBMD) and geometry by quantitative computed tomography (QCT), bone microstructure by high‐resolution peripheral QCT at the radius (HRpQCT), and vertebral compressive strength and load‐to‐strength ratio by finite‐element analysis (FEA) of lumbar spine QCT images. Compared with controls, women with grade 1 deformities had significantly worse values for many bone density, structure, and strength parameters, although deficits all were much worse for the women with grade 2–3 deformities. Likewise, these skeletal parameters were more strongly associated with moderate to severe than with mild deformities by age‐adjusted logistic regression. Nonetheless, grade 1 vertebral deformities were significantly associated with four of the five main variable categories assessed: bone density (lumbar spine vBMD), bone geometry (vertebral apparent cortical thickness), bone strength (overall vertebral compressive strength by FEA), and load‐to‐strength ratio (45‐degree forward bending ÷ vertebral compressive strength). Thus significantly impaired bone density, structure, and strength compared with controls indicate that many grade 1 deformities do represent early osteoporotic fractures, with corresponding implications for clinical decision making. © 2010 American Society for Bone and Mineral Research
    Keywords: Bone Density ; Bone Quality ; Finite‐Element Analysis ; Qct ; Vertebral Fracture
    ISSN: 0884-0431
    E-ISSN: 1523-4681
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