No abstract

Ventricular assist devices (VADs) are a surgical treatment for heart failure. These devices may be implanted as a bridge to transplant or as destination therapy. After surgical recovery and education regarding device care, patients are discharged home. Meticulous care of the driveline must be taken to prevent infection and trauma of the site throughout the perioperative event and for the duration of support. Currently a standardized protocol for care of the driveline and exit site does not exist. VAD coordinators from across the country discussed the variability in care at different centers in the United States through a series of conference calls. A survey consisting of 16 questions was developed. The survey included questions on preoperative antibiotic recommendations, driveline placement and exit site suturing, frequency of dressing changes, and showering practices. VAD coordinators shared center-specific dressing protocols and any driveline success stories. This survey was sent to 73 centers; 38 centers (52%) responded. The purpose of the survey was to define current practice in order to move toward a standard of practice or protocol based on expert opinion for VAD driveline care and to assess the need for future studies.

Several new synthetic methods have been developed for preparation of the rectangular tetrameric cluster complexes Mo4X8L4 (X = Cl, Br, I; L = neutral donor ligand). Mo4C18(CH3OH)4 is prepared efficiently from the dimer Mo2Cl4(PPh3)2(CH3OH)2 and subsequently converted in good yield to Mo4C18(C2H5CN)4 by reaction with propionitrile. Reaction of Mo4C18(C2H5CN)4 with triphenylphosphine yields Mo4Cl8(PPh3)4, and with tetrahydrofuran the unstable Mo4C18(THF)4 is afforded. The trialkylphosphine derivatives Mo4C18(PR3)4 (R = C2H5 or C4H9) may be obtained more conveniently in reactions between (a) K4Mo2C18 + PR3 (1:2 mole ratio), (b) Mo2(02CCH3)4 + PR3 + (CH3)3SiCl (1:2:4 mole ratio), (c) Mo2(02CCH3)4 + PR3 + A1C13 (1:2:2 mole ratio), or (d) Mo2C14(PR3)4 + Mo(CO)6 (1:1 mole ratio). The Mo4Br8(P-n-Bu3)4 prepared by analogous methods exhibits properties closely related to the chloride derivative; Mo4I8(P-n-Bu3)4 however appears to consist of weakly coupled quadruply bonded dimers. The various compounds have been characterized by UV-visible, infrared, and Cl 2p photoelectron spectra which reflect the basic rectangular cluster structure known for Mo4Cl8(PEt3)4.

No abstract

No abstract

Objective The effect of body habitus for patients who require extracorporeal membrane oxygenation (ECMO) support has not been well‐studied and may provide insight into patient survival and outcomes. We sought to determine if there is a correlation of body mass index (BMI) with ECMO outcomes. Methods A retrospective chart review was performed for patients who required any form of ECMO support at our institution between 2012 and 2016. Time variables (overall hospital length of stay, intensive care, and ventilator days), and outcomes variables (ability to wean from ECMO, extubation status, hospital survival, 30‐day survival) were studied. Patients were divided into cohorts based on BMI. Descriptive statistics were used to summarize data. Spearman correlation, Fisher's exact test, and independent t‐test were used to assess associations. Results A total of 231 patients required ECMO with a mean BMI of 29 (±6.47; BMI range, 17.6‐57.9). The mean BMI did not differ based on type of support provided (veno‐veno ECMO [VV] vs veno‐arterial [VA]). There was no difference between BMI cohorts for length of stay, time in the intensive care unit (ICU), ability to wean from ECMO, hospital survival or 30‐day survival. Raw BMI did not predict if or when patients were extubated. Conclusions Neither obesity classification nor BMI as a continuous variable affected any of the outcome variables. Respiratory outcomes including the ability to extubate and to remain ventilator‐free were also independent of patient BMI. These data suggest that extremes of body habitus alone should not be used as an exclusion criteria for consideration of ECMO support.

For patients with chronic renal failure, peritoneal dialysis (PD) is a common, life sustaining form of renal replacement therapy that is used worldwide. Exposure to nonbiocompatible dialysate, inflammation, and uremia induces longitudinal changes in the peritoneal membrane. Application of molecular biology techniques has led to advances in our understanding of the mechanism of injury of the peritoneal membrane. This understanding will allow for the development of strategies to preserve the peritoneal membrane structure and function. This may decrease the occurrence of PD technique failure and improve patient outcomes of morbidity and mortality.

Outcomes for repeat ECMO patients compare favorably to the overall ECMO population and suggest a need to explore and broaden the clinical indications for repeat ECMO.