Commencement Service 5-17-2024

Commencement Service 5-17-2024https://scholar.csl.edu/academic_services/1010/thumbnail.jp

Extracorporeal Membrane Oxygenation in Congenital Heart Disease

Mechanical circulatory support (MCS) is a key therapy in the management of patients with severe cardiac disease or respiratory failure. There are two major forms of MCS commonly employed in the pediatric population—extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD). These modalities have overlapping but distinct roles in the management of pediatric patients with severe cardiopulmonary compromise. The use of ECMO to provide circulatory support arose from the development of the first membrane oxygenator by George Clowes in 1957, and subsequent incorporation into pediatric cardiopulmonary bypass (CPB) by Dorson and colleagues. The first successful application of ECMO in children with congenital heart disease undergoing cardiac surgery was reported by Baffes et al. in 1970. For the ensuing nearly two decades, ECMO was performed sparingly and only in specialized centers with varying degrees of success. The formation of the Extracorporeal Life Support Organization (ELSO) in 1989 allowed for the collation of ECMO-related data across multiple centers for the first time. This facilitated development of consensus guidelines for the use of ECMO in various populations. Coupled with improving ECMO technology, these advances resulted in significant improvements in ECMO utilization, morbidity, and mortality. This article will review the use of ECMO in children with congenital heart disease

Technique For Trileaflet Expanded Polytetrafluoroethylene Valved Conduit Creation

The technique in this video demonstrates how to implant a leaflet apparatus into any conduit type. This includes conduits not previously demonstrated, such as ring-reinforced ePTFE and sinus of Valsalva conduits. Utilizing this technique, the cost of one conduit is $828 –$1,033 compared to commercially available conduits, which cost $4,995 –$12,500.Advantages of handmade conduits with bileaflet and trileaflet ePTFE valves are well documented in right ventricular outflow tract (RVOT) reconstruction. With comparable results to commercially available conduits, ePTFE conduits are also more available, durable, and significantly cheaper. This video presents a technique to construct trileaflet ePTFE conduits that will offer unparalleled customizability in RVOT reconstruction. Based on design from the Ando/Takahashi group experience, several modifications were made to allow for creation of bespoke conduits in sizes from 5 mm – 38 mm in any conduit type.Patients undergoing a Norwood Procedure with high PVR, such as an intact atrial septum, or those with systemic atrioventricular valve or neo-aortic valve regurgitation could potentially benefit from a trileaflet valve in a 5 or 6 mm ring-reinforced ePTFE conduit. Biologic valved conduits have been used in this position (cryopreserved vein graft, homograft/ePTFE composites, etc.) with reasonable success in the immediate postoperative period. However, nearly all required conduit reintervention in the interstage period. The technique in this video describes a more durable solution that could last the entire interstage period.The authors have implanted eighteen conduits in sizes 10 mm – 32 mm in patients from 3.8 – 114.3 kg since 2020. One conduit used in a salvage ECMO case was stented early. All others have no more than mild stenosis, with max 18 mmHg in one patient, and trivial regurgitation via TTE.</p

Effect of Antimicrobial Treatment on the Dynamics of Ceftiofur Resistance in Enterobacteriaceae from Adult California Dairy Cows.

Dairy farm use of antimicrobial drugs (AMD) is a risk for the selection of antimicrobial resistance (AMR); however, these resistance dynamics are not fully understood. A cohort study on two dairy farms enrolled 96 cows with their fecal samples collected three times weekly, for the first 60 days in milk. Enterobacteriaceae were enumerated by spiral plating samples onto MacConkey agar impregnated with 0, 1, 8, 16 and 30 µg/mL ceftiofur. Negative binomial regression analyzed AMR over time. The continuum of ceftiofur concentrations permitted estimation of the minimum inhibitory concentration (MIC) and analysis using interval regression. The most common systemic AMD was ceftiofur, administered in 94% of treatments (15/16 cows). Enterobacteriaceae did not grow in 88% of samples collected from non-AMD treated cows at 8 µg/mL ceftiofur. Samples from AMD treated cows had peak counts of resistant Enterobacteriaceae during AMD treatment and returned to baseline counts by 3-4 days post-treatment at 8 µg/mL. Sensitive Enterobacteriaceae (0-1 µg/mL ceftiofur) were reduced below pre-treated levels for 29-35 days post-AMD treatment. Population MIC peaked during AMD treatment and returned to baseline levels by 7-8 days. We conclude that the effect of systemic ceftiofur on the resistance of Enterobacteriaceae in early lactation dairy cows was limited in duration

Effect of Antimicrobial Treatment on the Dynamics of Ceftiofur Resistance in Enterobacteriaceae from Adult California Dairy Cows.

Dairy farm use of antimicrobial drugs (AMD) is a risk for the selection of antimicrobial resistance (AMR); however, these resistance dynamics are not fully understood. A cohort study on two dairy farms enrolled 96 cows with their fecal samples collected three times weekly, for the first 60 days in milk. Enterobacteriaceae were enumerated by spiral plating samples onto MacConkey agar impregnated with 0, 1, 8, 16 and 30 µg/mL ceftiofur. Negative binomial regression analyzed AMR over time. The continuum of ceftiofur concentrations permitted estimation of the minimum inhibitory concentration (MIC) and analysis using interval regression. The most common systemic AMD was ceftiofur, administered in 94% of treatments (15/16 cows). Enterobacteriaceae did not grow in 88% of samples collected from non-AMD treated cows at 8 µg/mL ceftiofur. Samples from AMD treated cows had peak counts of resistant Enterobacteriaceae during AMD treatment and returned to baseline counts by 3-4 days post-treatment at 8 µg/mL. Sensitive Enterobacteriaceae (0-1 µg/mL ceftiofur) were reduced below pre-treated levels for 29-35 days post-AMD treatment. Population MIC peaked during AMD treatment and returned to baseline levels by 7-8 days. We conclude that the effect of systemic ceftiofur on the resistance of Enterobacteriaceae in early lactation dairy cows was limited in duration

Oklahoma Agricultural Experiment Station, Bulletin no. 814, May 2000: So you want to be a rancher?

The Oklahoma Agricultural Experiment Station periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

Estimating the Rates of Acquisition and loss of Resistance of Enterobacteriaceae to Antimicrobial Drugs in Pre-Weaned Dairy Calves.

The objective of this study was to investigate the effect of the antimicrobial drugs (AMD) on the shedding of resistant Enterobacteriaceae in feces of pre-weaned dairy calves. The AMD considered were ceftiofur, administered parenterally, and neomycin sulfate added in milk replacer and fed to calves during the first 20 days of life. Fifty-five calves, aged one to three days, were enrolled and followed to 64 days. Fecal samples were collected three times/week and treatments recorded daily. Enterobacteriaceae were quantified for a subset of 33 calves using spiral plating on plain, ceftiofur supplemented, and neomycin supplemented MacConkey agar. Negative binomial models were used to predict the association between treatment with AMD and the gain and loss of Enterobacteriaceae resistance over time. Acquisition of resistance by the Enterobacteriaceae occurred during treatment and peaked between days three to four post-treatment before decreasing to below treatment levels at days seven to eight post-treatment. Acquisition of neomycin resistance was observed on the first sampling day (day four from the start of feeding medicated milk replacer) to day eight, followed by cyclical peaks until day 29, when the Enterobacteriaceae counts decreased below pre-treatment. Enterobacteriaceae resistance against both AMD increased after AMD administration and didn't return to pre-therapeutic status until seven or more days after therapy had been discontinued. The study findings provide valuable insights into the dynamics of Enterobacteriaceae under routine AMD use in calves