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Backround The risk assessment of intraductal papillary mucinous neoplasms (IPMN) to either guide patients to surgical resection or watchful waiting is still under debate. Additional markers to better separate low and high-risk lesions would improve patient selection. Methods Patients who underwent pancreatic resections for IPMNs between January 2008 and December 2012 with available blood samples were selected and retrospectively assessed. Data on cyst characteristics such as cyst size, duct relation and main-duct dilatation were collected and plasma fibrinogen levels were measured. Results A total of 73 patients fulfilled the inclusion criteria by pancreatic resection for pathologically confirmed IPMN and available blood sample. Histologically, IPMNs were classified as low-grade and borderline in 52 (71.2%, group 1) and as high-grade and invasive in 21 (28.8%, group 2) of all cases. Fibrinogen levels showed significant differences between the two groups (group 1: mean 3.62 g/L (SD ± 1.14); group 2: mean 4.49 g/L (SD ± 1.57); p = 0.027). A ROC-curve analysis calculated cut-off value of 4.71 g/L separated groups 1 and 2 (p = 0.008). Fibrinogen levels remained as the only significant factor in multivariable analysis, cyst size and duct relation were not significant. Conclusion Blood fibrinogen differed between low and high risk IPMNs and therefore, the use of fibrinogen as an additional discriminator in the pre-operative risk assessment of IPMNs should be further evaluated. [ABSTRACT FROM AUTHOR]

B Background: b The risk assessment of intraductal papillary mucinous neoplasms (IPMN) to either guide patients to surgical resection or watchful waiting is still under debate. B Conclusion: b Blood fibrinogen differed between low and high risk IPMNs and therefore, the use of fibrinogen as an additional discriminator in the pre-operative risk assessment of IPMNs should be further evaluated. [Extracted from the article]

The application of digital imaging and communications in medicine data with z-brush three-dimensional software - how can the design and fabrication of an epithesis be supported by it?. [Extracted from the article]

Left ventricular assist device (LVAD) implantation and survival is increasing. With patients living longer on device support, LVAD-related healthcare costs and hospitalizations, including those for volume overload, are on the rise as well. The Johns Hopkins Heart Failure Bridge Clinic (HFBC), a HF-trained Nurse Practitioner (NP) led clinic with ability to administer outpatient intravenous (IV) diuretics, has resulted in significant reductions in HF readmission rates. We developed a protocol for LVAD patient assessment and management via the HFBC, and describe our initial experience regarding the role and efficacy of this unique program in outpatient management of HF in LVAD patients. LVAD patients were evaluated by an LVAD provider and subsequently referred to the diuresis clinic for volume overload thought not to be related to an LVAD issue. If seen in the diuresis clinic, patients then had repeat evaluation with the LVAD/HF team within one week. Baseline characteristics and HF outcomes were assessed. Nineteen LVAD patients were seen in the diuresis clinic a total of 65 times. IV furosemide was administered 31 times to 13 patients (mean dose 80 ± 23.5 mg). Urine output during first in clinic void after IV diuretic was 125 ± 53 mL. At 30 of 65 (46%) visits, oral diuretic dose was uptitrated. Potassium was given at 18 of the 65 (27.7%) visits. There were no significant changes in blood pressure, renal function, or electrolytes post diuresis. Only 1 of 65 patient visits resulted in direct hospital admission (hyponatremia). All other visits discharged to home in improved/stable condition and avoidance of hospitalization for heart failure. During follow up, only 6 of 19 patients were hospitalized for a primary diagnosis of volume overload. We describe successful implementation of an outpatient IV diuresis protocol for treatment of HF in LVAD patients. The strategy has major implications in reducing LVAD-related HF hospitalizations and healthcare utilization [ABSTRACT FROM AUTHOR]