The increase compared to NORM in VEGF and VEGF-R mRNA expression in horses with LCV may be important in early intestinal healing and may also explain, in part, the increase in vascular permeability in horses with a LCV. Expression of IGF and IGF-R in the SI warrants further investigation and may be important for understanding post operative complications in horses with SI lesions.

No abstract

had > 2 opioid prescriptions, we identified beneficiaries with high-dose use (> 120 daily morphine milligram equivalents for ≥ 90 consecutive days) and multiple providers (≥ 4 prescribers and ≥ 4 pharmacies) each year; and concurrent benzodiazepine use (≥ 30 cumulative days) from 2013-2015 when Part D began coverage for benzodiazepines. We obtained adjusted annual rates of high-risk measures across 306 hospital referral regions (HRRs) using multivariable logistic regression and examined the association between these measures and overdose risk(claimbased) in the subsequent year using Cox proportional regression, adjusting for sociodemographic, health status, and access-to-care factors. ReSultS: Adjusted annual rates of high-dose use (~9%), having multiple providers(~5%), and concurrent benzodiazepine use (~34%) remained stable over five years. In 2015, the ratio of 75th-to-25th percentile rates of high-risk measures across HRRs were 1.80 for high-dose use, 1.87 for having multiple providers, and 1.33 for concurrent benzodiazepine use. The top 3 HRRs with the highest rate of: high-dose use were Sarasota, FL(17.2%), Sun City, AZ(17.2%) and Clearwater, FL(16.9%); multiple providers were Slidell, LA(14.0%), Muskegon, MI(12.5%), and Bryan, TX(12.0%); and concurrent benzodiazepine use were Dearborn, MI(58.0%), Miami, FL(55.4%), and Spartanburg, SC(55.1%). These measures were associated with subsequent overdose risk for high-dose (hazard ratio [HR]= 2.19, 95%CI= 1.86-2.57); multiple providers (HR= 1.58,; and concurrent benzodiazepine use (HR= 1.82, 95%CI= 1.58-2.10). ConCluSionS: High-risk opioid use measures were associated with overdose risk among disabled Medicare beneficiaries. Areas and individuals with prevalent high-risk opioid use may benefit from targeted interventions (e.g.,lock-in programs) to prevent overdose. MH4

Background: Procedural success of linear ablation for typical right atrial flutter may be impacted by anatomic variation in the cavotricuspid isthmus (CTI). We report on the utility of intracardiac echocardiography (ICE) for direct visualisation of the CTI during ablation.Methods: The cohort included 35 patients undergoing ICE for concomitant CTI ablation with left atrial catheter ablation procedures for atrial fibrillation. Results: Ablation operator technique was frequently modified in response to direct visualisation of CTI anatomy with ICE. ICE allowed confirmation of catheter reach and tissue contact in all patients. Ablation approach was modified for anatomic variants including prominent muscular ridges and Eustachian valves. Bidirectional linear block was achieved in all patients.Conclusion: The long term success of CTI ablation may be impacted by direct visualization of CTI anatomy with ICE during ablation delivery.

Results: 159 CRT procedures in 139 patients were performed between 2000 and April 2011. Sixty-three percent were new device implants, 23% upgrade from standard pacemaker to CRT, 12% lead change or repositioning. Of new implants: median age 62yrs, 77% male, 34% ischaemic cardiomyopathy, 11% in atrial fibrillation, median LV ejection fraction 25% (interquartile range (IQR) 19-30%), 91% LBBB, median QRS duration 170 ms (IQR 160-200 ms), 49% received CRT with defibrillator. Median procedure time was 140 min (IQR 102-180 min). Median fluoroscopy time was 27 min (IQR 16-41 min).Eight patients suffered a significant complication (6%), including: one death, two infections requiring extraction, three haematomas requiring evacuation, one pneumothorax, and one tamponade. In addition there were 23 lead displacements in 19 patients (14%), and failure to implant the CRT device occurred in 17 patients (12%) (usually due to an inability to place the LV lead).Conclusions: Our patient population is similar to that of the large randomised trials from which data supporting CRT are derived. Our rates of lead dislodgement and failure to achieve device implantation are higher than reported in these trials, while our rate of other complications is similar.http://dx.