Others titles

  • Entres Pubmed
  • Pubmed Research Papers
  • MEDLINE/PubMed Data
  • MEDLINE/PubMed Baseline


  • Pubmed Journals
  • NCBI Pubmed
  • Medline Search
  • Pubmed Citation
  • Medline Articles
  • MESH Terminology

MEDLINE PubMed Journal Citation Database

This dataset contains NLM’s database of citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, health care systems, and preclinical sciences.

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John Snow Labs Standard End User License Agreement

Last updated:January 20, 2021

This Standard End User License Agreement (“EULA”) applies to customers of John Snow Labs Inc. (as defined below), using any product of John Snow Labs Inc. on John Snow Labs Marketplace as defined below (hereinafter referred to “you”) and John Snow Labs Inc., a Delaware corporation (“John Snow Labs”, “we” or “us”).

By downloading, installing, and/or using (as applicable) any Product of John Snow Labs (as defined below), you automatically agree to be bound by, and use our Products in compliance with, this EULA. This EULA, together with additional terms and conditions and/or policies referenced herein or located on https://www.johnsnowlabs.com and/or conveyed to you by John Snow Labs, is a legally binding contract between you and John Snow Labs.


We may make changes to this EULA from time to time. When we do so, we will revise the “last updated” date given above. The then-current version of this EULA will supersede all earlier versions. You agree that your continued use of our Products after such changes have been published to our EULA will constitute your acceptance of such revised EULA.


“John Snow Labs Data Library” means a data library located at https://www.johnsnowlabs.com;

“Products” means products and services of John Snow Labs that you download and use from listings in John Snow Labs Data Library;

Important Notice

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Your Access and Use

Subject to your compliance with this EULA, as well as any other applicable policies, John Snow Labs grants you non-exclusive, non-transferable, license to install, access to, modify, and use of, the Products worldwide (subject to applicable export laws) during the term of this EULA (as described below) solely for research, private study and personal use of Products.

This license is personal to you, and you may not resell our Products, permit other users access to our Products through your account. Your right to use our Products is limited by all terms and conditions set forth in this EULA.

Except for your pre-existing rights and this license granted to you, we and our licensors retain all rights, titles and interests in and to our Products, all related intellectual property rights, including trademarks (whether registered or pending), domain and business names. Our Products are protected by applicable intellectual property laws, including United States copyright law and international treaties.

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Except as otherwise explicitly provided in this EULA or as may be expressly permitted by applicable law, you will not, and will not permit or authorize any third party to:

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Your use of the Products is subject to our fees. All fees are given on our website https://www.johnsnowlabs.com. Except as set forth in this EULA, the fees are non-refundable. We are entitled to revise our fees from time to time.

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Term and Termination

This EULA will become effective as of the date of your order of Products and shall be in effect until terminated.

John Snow Labs may suspend or terminate your right to use our Products, if you or your end user’s use of the Products:

  1. is in breach of this EULA;
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We may also suspend or terminate your right to use our Products, if you fail to perform your payment obligations, or you have ceased to operate in the ordinary course, made an assignment for the benefit of creditors or similar disposition of your assets, or become the subject of any bankruptcy, reorganization, liquidation, dissolution or similar proceeding.

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You will cease use of the Products during any period of suspension, or upon termination of this EULA.

All provisions which by their nature are intended to survive termination shall survive termination of this EULA.


If applicable to your Product, John Snow Labs will provide you with the support services. If you use a trial access, support services are excluded. Under this EULA, our support services exclude any installation, training, maintenance services (including any error corrections, bug fixes, or new releases), technical assistance, consulting services, or other services of any kind. Such services are provided at John Snow Labs’ discretion.

From time to time John Snow Labs can perform updates to our software. If available, such updates may include bug fixes, new features and/or enhancements. You are solely responsible for deploying such updates at your own risk and liability.

Access to our Products

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Privacy Policy

We may collect, store and receive personal and other information about you through our Products. Our collection and use of this information is governed by our Privacy Policy available at https://www.JohnSnowLabs.com/privacy/ which may be amended from time to time.

Links and Third Party Content

Our Products may display, or contain links to, third party products, services, and websites. Any opinions, advice, statements, services, offers, or other information that constitutes part of the content expressed, authored, or made available by other users or other third parties, or which is accessible through or may be located using our Products (collectively, “Third Party Content”) are those of the respective authors or producers and not of us or our shareholders, directors, officers, employees, agents, or representatives.

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Proprietary Rights

John Snow Labs will not obtain any rights under this EULA from you (or your licensors) to your content.

The Products, including software, is and remains the exclusive property of John Snow Labs and its licensors. Except for the access and use rights expressly set forth in this EULA, no license or other rights in or to the Products or John Snow Labs trademark(s) and other intellectual property rights therein, are granted to you, and all such licenses and rights are expressly reserved. You will not remove, alter, or obscure any proprietary notices (including copyright and trademark notices) on any portion of our Products or any Content.


“John Snow Labs,” the John Snow Labs logo, and any other product, business or service name or slogan, whether registered or pending, displayed on our Products are trademarks of John Snow Labs, Inc. or its suppliers or licensors, and may not be copied, imitated or used, in whole or in part, without the prior written permission of John Snow Labs or the applicable trademark holder. You may not use any metatags or any other “hidden text” utilizing “John Snow Labs” or any other name, trademark or product, business or service name of John Snow Labs without our prior written permission. In addition, the look and feel of our Products, including all page headers, custom graphics, button icons and scripts, is the service mark, trademark and/or trade dress of John Snow Labs and may not be copied, imitated or used, in whole or in part, without our prior written permission. All other trademarks, pending trademarks, registered trademarks, product names and company names or logos mentioned in our Products are the property of John Snow Labs Inc. and/or their respective owners. Reference to any products, services, processes or other information, by trade name, trademark, manufacturer, supplier, or otherwise does not constitute or imply endorsement, sponsorship, or recommendation thereof by us.

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Limitation of Liability



To the full extent permitted by applicable law, you shall defend, indemnify and hold harmless John Snow Labs, its affiliates and its licensors, and each of their respective employees, officers, directors, and representatives from and against any claims, damages, losses, liabilities, costs, and expenses (including reasonable attorney’s fees) arising out of or relating to any third party claim concerning: (a) your use of the Products; (b) breach of this EULA or violation of applicable law by you; (c) any content or the combination of such content with other software, content or processes, including any claim involving alleged infringement or misappropriation of third-party rights by such content or combination; or (d) breach of any obligation or duty you owe to a third party.

Legal Notices

Enforcement of this EULA will be governed by the laws of the State of Delaware, excluding its conflict and choice of law principles. The exclusive jurisdiction and venue for any claims arising out of or related to this EULA or your use of the Products will lie in the state and federal courts located in Sussex County, within the State of Delaware, and you irrevocably agree to submit to the jurisdiction of such courts. Our failure to enforce any right or provision in this EULA will not constitute a waiver of such right or provision unless acknowledged and agreed by us in writing. In the event that a court of competent jurisdiction finds any provision of this EULA to be illegal, invalid, or unenforceable, the remaining provisions will remain in full force and effect.


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Contacting Us

If you have any questions or concerns about our Products or this EULA, you may contact us by email at support@JohnSnowLabs.com.


MEDLINE is the U.S. National Library of Medicine® (NLM) premier bibliographic database that contains more than 23 million references to journal articles in life sciences with a concentration on biomedicine. A distinctive feature of MEDLINE is that the records are indexed with NLM Medical Subject Headings (MeSH®)

The subject scope of MEDLINE is biomedicine and health, broadly defined to encompass those areas of the life sciences, behavioral sciences, chemical sciences, and bioengineering needed by health professionals and others engaged in basic research and clinical care, public health, health policy development, or related educational activities. MEDLINE also covers life sciences vital to biomedical practitioners, researchers, and educators, including aspects of biology, environmental science, marine biology, plant and animal science as well as biophysics and chemistry. Publishers submit journals to an NIH-chartered advisory committee, the Literature Selection Technical Review Committee (LSTRC), which reviews and recommends journals for MEDLINE. The LSTRC considers the quality of the scientific content of a journal, including originality and the importance of the content for the MEDLINE global audience, using the guidelines found on the NLM Fact Sheet MEDLINE Journal Selection.

MEDLINE is the primary component of PubMed®, part of the Entrez series of databases provided by the NLM National Center for Biotechnology Information (NCBI). In addition to MEDLINE citations, PubMed also contains:
– In-process citations that provide a record for an article before it is indexed with MeSH® and added to MEDLINE or converted to out-of-scope status.
– Citations that precede the date that a journal was selected for MEDLINE indexing.
– Some OLDMEDLINE citations that have not yet been updated with current vocabulary and converted to MEDLINE status.
– Citations to articles that are out-of-scope (e.g., covering plate tectonics or astrophysics) from certain MEDLINE journals, primarily general science and general chemistry journals, for which the life sciences articles are indexed with MeSH for MEDLINE.
– Citations to some additional life science journals that submit full-text articles to PMC® (PubMed Central®) and receive a qualitative review by NLM.
– Citations for the majority of books and book chapters available on the NCBI Bookshelf.

MedlineCitation Status attribute

1. In-Data-Review
Records submitted to NLM electronically by publishers are added to PubMed at NLM and given in In-Data-Review status. Records in this status have undergone review at the journal issue level; i.e., the journal title, date of publication and volume/issue elements (referred to as the source data) are checked. They are not yet MEDLINE records because they have not undergone complete quality review and MeSH indexing; thus they should not be identified as MEDLINE records.

2. In-Process
Records in this status have undergone a citation level review; i.e., the author names, article title, and pagination are checked. All In-Data-Review records that entered the workflow via publisher electronic submission are redistributed again in In-Process status whether or not they were revised as a result of the second citation level review, and are not identified in any way as having been revised or not having been revised. Records created via NLM current other data entry mechanism, scanning/optical character recognition (OCR), are distributed for the first time in In-Process status after their creation. They are not yet MEDLINE records because they have not undergone complete quality review and MeSH indexing; thus they should not be identified as MEDLINE records. Most in-process records are eventually indexed with MeSH Headings and are elevated to completed MEDLINE status. However, some are determined to be out of scope (e.g., articles on plate tectonics or astrophysics from certain MEDLINE journals, primarily general science and chemistry journals, for which the life sciences articles are indexed for MEDLINE) and are not elevated to MEDLINE status; instead they become PubMed-not-Medline final status records. In rare cases the records are deleted and do not become PubMed-not-MEDLINE records.

In-process records undergo rigorous quality assurance routines before they are elevated to MEDLINE status or to PubMed-not-MEDLINE status. Records in MEDLINE status are the only ‘true’ MEDLINE records .

A small percentage of the records in the OLDMEDLINE subset are in MedlineCitation Status = OLDMEDLINE. The criterion for records to be in OLDMEDLINE status is that all the original MeSH Headings have not yet been mapped to current MeSH. NLM exports both new and revised OLDMEDLINE records on an irregular and infrequent basis.

5. PubMed-not-MEDLINE
Records in this status are from journals included in MEDLINE and have undergone quality review but are not assigned MeSH headings because the cited item is not in scope for MEDLINE either by topic or by date of publication, or from non-MEDLINE journals and have undergone quality review.

6. Publisher
Records in Publisher status are not distributed via bulk download. At this time approximately 98% of PubMed’s content is distributed via bulk download. At any given time, there are between 400,000 to 500,000 additional records in Publisher MedlineCitation Status in PubMed. These are citations to author manuscripts of articles published by NIH-funded researchers and citations to books in the NCBI Bookshelf etc.

Citation Subset
The values and their definitions for Citation Subset are as follows. Note that several are closed subsets no longer being assigned.
AIM = citations from Abridged Index Medicus journals, a list of about 120 core clinical, English language journals.
B = citations from non-Index Medicus journals in the field of biotechnology (not currently used).
C = citations from non-Index Medicus journals in the field of communication disorders (not currently used).
D = citations from dental journals.
E = citations in the field of bioethics (includes records from the former BIOETHICS database).
F = older citations from one journal prior to its selection for Index Medicus; used to augment the database for NLM International MEDLARS Centers (not currently used).
H = citations from non-Index Medicus journals in the field of health administration (includes records from the former HealthSTAR database).
IM = citations from Index Medicus journals.
J = citations in the field of population information (not currently used; on records from the former POPLINE® database).
K = citations from non-Index Medicus journals relating to consumer health.
N = citations from nursing journals.
OM = pre-1966 citations from the older print indices of the Cumulated Index Medicus (CIM) and the Current List of Medical Literature (CLML).
Q = citations in the field of the history of medicine (includes records from the former HISTLINE® database).
QIS = citations from non-Index Medicus journals in the field of the history of medicine. (For NLM use effective in late 2006 because they require special handling at NLM; not a subset of Q; some journals previously designated as Q are now QIS.)
QO is subset of Q – indicates older history of medicine journal citations that were created before the former HISTLINE file was converted to a MEDLINE-like format. (For NLM use because they require special handling at NLM.)
R = citations from non-Index Medicus journals in the field of population and reproduction (not currently used).
S = citations in the field of space life sciences (includes records from the former SPACELINE™ database).
T = citations from non-Index Medicus journals in the field of health technology assessment (includes records from the former HealthSTAR database).
X = citations in the field of AIDS/HIV (includes records from the former AIDSLINE® database).

About this Dataset

Data Info

Date Created


Last Modified




Update Frequency


Temporal Coverage

1946 to 2018

Spatial Coverage



John Snow Labs; National Library of Medicine (NLM);

Source License URL

Source License Requirements


Source Citation



Pubmed Journals, NCBI Pubmed, Medline Search, Pubmed Citation, Medline Articles, MESH Terminology

Other Titles

Entres Pubmed, Pubmed Research Papers, MEDLINE/PubMed Data, MEDLINE/PubMed Baseline, MEDLINE/PubMed XML

Data Fields

Name Description Type Constraints
PubMed_IDThe PubMed unique identifier, is a 1 to 8-digit accession number with no leading zeros.integerrequired : 1level : Nominal
PubMed_VersionUsed to accommodate the model of publishing known as "versioning"integerrequired : 1level : Interval
Citation_StatusIndicates the stage of a citation.stringrequired : 1enum : Array ( [0] => In-Process [1] => PubMed-not-MEDLINE [2] => In-Data-Review [3] => Publisher [4] => MEDLINE [5] => OLDMEDLINE )
Citation_OwnerIndicates the The party responsible for creating and validating the citation. Each citation has only one MedlineCitation Ownerstringrequired : 1enum : Array ( [0] => NLM [1] => NASA [2] => PIP [3] => KIE [4] => HSR [5] => HMD [6] => SIS [7] => NOTNLM )
Citation_VersionIDUsed with “versioned” citationsstring-
Citation_Version_DateUsed with “versioned” citationsdate-
Citation_Indexing_MethodIndexing method used for citationstring-
Citation_Record_Completed_DateDate processing of the record ends i.e., MeSH Headings have been added, quality assurance validations are completed, and the completed record subsequently is distributed to PubMed.date-
Citation_Record_Revised_DateMay reside on records with Status = MEDLINE, OLDMEDLINE, and PubMed-not-MEDLINE. It identifies the date a change is made to a record in one of those statuses, either as a result of individual or global maintenance.date-
Citation_Other_SourceIDidentifies a.) the organization responsible for the information on the citation or the document where the information originated, and b.) a unique number for that citation or document.string-
Citation_Other_Abstract_TextIndicates the abstract created by a collaborating partner or other entitystring-
Citation_Other_Abstract_Text_TypeType of Other Abstractstring-
Citation_Other_Abstract_Text_LanguageIndicate on behalf of publishers that there are additional abstracts available at the publishers' Web sites or elsewhere.string-
Citation_Other_Abstract_Text_Copyright_InfoIndicate copyright statement provided by the publisher of the journalstring-
Citation_Mesh_Headings_ListNLM controlled vocabulary, Medical Subject Headings (MeSH®), is used to characterize the content of the articles represented by MEDLINE citationsstring-
Citation_Chemical_Drug_ListContains one or more chemicals or drugs,which are displayed as registry number and name of substance.string-
Citation_Protocol_Disease_ListIndicates Protocol Class 2 Supplementary Concept Record (SCR) terms and Disease Class 3 SCR termsstring-
Citation_Keywords_ListContains controlled terms that describe the content of the article.string-
Citation_Number_Of_ReferencesContains the number of bibliographic references listed in the article.integerlevel : Ratio
Citation_Subsetidentifies the subset for which MEDLINE records from certain journal lists or records on specialized topics were created. Some of these values are found on extremely small numbers of records.string-
Citation_Comments_CorrectionsThese data pertain to and contain citations to associated journal publications, e.g., comments, errata, retractions, or cited references, and enable outside links between the record at hand to its associated citation(s).string-
Citation_Gene_Symbol_ListContains the "symbol" or abbreviated form of gene names as reported in the literature.string-
Citation_Personal_Name_Subject_ListUsed for citations that contain a biographical note or obituary, or are entirely about the life or work of an individual or individuals.string-
Citation_Space_Flight_MissionContains the space flight mission name and/or number when results of research conducted in space are covered in a publication.string-
Citation_Investigator_ListContain personal names of individuals (e.g., collaborators and investigators) who are not authors of a paper but rather are listed in the paper as members of a collective/corporate group that is an author of the paper.string-
Citation_General_NoteContains supplemental or descriptive information related to the document cited in the MEDLINE record. It is a 'catchall' for various types of information included by NLM collaborating producers or by NLM.string-
Citation_Conflict_Of_Interest_StatementConflict of interest statementstring-
Journal_ISSNISSN (International Standard Serial Number) is always an eight-character value that uniquely identifies the cited journal. It is nine characters long in the hyphenated form: XXXX-XXXX.string-
Journal_ISSN_TypeIndicates which of the ISSNs assigned to the journal is recorded in the citation.stringenum : Array ( [0] => Electronic [1] => Print [2] => Undetermined )
Journal_TitleThe full journal titlestringrequired : 1
Journal_Title_ISO_AbbreviationISO Abbreviations are constructed at NLM to assist NCBI in linking from GenBank to PubMed. ISO Abbreviations created after 2007 are identical to the NLM title abbreviations.string-
Journal_Cited_MediumIndicates whether a citation is processed/indexed at NLM from the online or the print version of the journal.stringenum : Array ( [0] => Internet [1] => Print )
Journal_Volume_IssueThe volume number and the issue (part or supplement) of the journal in which the article was published.string-
Journal_Published_DateContains the full date on which the issue of the journal was publishedstring-
Journal_Published_CountryContains the place of publication of the journal.string-
Journal_Title_Standard_AbbreviationContains the standard abbreviation for the title of the journal in which an article appeared.string-
Journal_NLM_IDIt may appear as seven, eight or nine charcaters and is the preferred element to use when looking for the serial record for the journal in which the article was published.stringrequired : 1
Journal_ISSN_LinkingContains the ISSN designated by the ISSN Network to enable co-location or linking among the different media versions of a continuing resourcestring-
Article_TitleContains the entire title of the journal article.It is always in English; those titles originally published in a non-English language and translated are enclosed in square brackets.string-
Article_AuthorsContains the Personal and collective (corporate) author names published with the article.It includes author's lastname, forename, suffix, collective (corporate) names and affliation informationstring-
Article_LanguageContains the The language in which an article was published.stringrequired : 1
Article_Publish_ModelIdentify the medium/media in which the cited article is published.stringrequired : 1enum : Array ( [0] => Print [1] => Print-Electronic [2] => Electronic [3] => Electronic-Print [4] => Electronic-eCollection )
Article_Abstract_TextEnglish-language abstracts taken directly from the published article. Abstracts in records may be truncated.string-
Article_Abstract_Text_Copyright_InfoContains a copyright statement provided by the publisher of the journal and appears only on records supplied electronically to NLM by the publisher.string-
Article_Publication_TypesIt identifies the type of article indexed for MEDLINE; it characterizes the nature of the information or the manner in which it is conveyed as well as the type of research support received (e.g., Review, Letter, Retracted Publication, Clinical Conference, Research Support, N.I.H., Extramural).string-
Article_PaginationIndicates the inclusive pages for the article cited.string-
Article_ELocationIDProvides an electronic location for items which lack standard page numbers. The element houses Digital Object Identifiers (DOIs) or Publisher Item Identifiers (PIIs) that are provided by publishers for new citations submitted to NLM for inclusion in MEDLINE/PubMed.string-
Article_DataBank_ListContains information pertaining to the registration of several types of data: 1) molecular sequence data; 2) clinical trial numbers; 3) gene expression/molecular abundance data; 4) PubChem identifiers; 5)Two general research databanks, the Dryad Digital Repository and figshare; and 6) BioProject identifiers.string-
Article_Grant_ListContains following information 1) research grant or contract number 2) grant acronym 3) institute acronym followed by the agency's hierarchical structure from lower to higher entity or agency name 4) country of the granting agencystring-
Article_Vernacular_TitleUsed for articles published in non-English languages and contains the original, untranslated title.string-
Article_Electronic_Published_DateContains the date the publisher made an electronic version of the articledate-
PubMed_HistoryChanges in the pubmed records, along with the status and the dates when it was changedstring-
PubMed_Publication_StatusPublication status of the recordstring-
PubMed_ArticleID_ListList of article ids and typesstring-

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PubMed IDPubMed VersionCitation StatusCitation OwnerCitation VersionIDCitation Version DateCitation Indexing MethodCitation Record Completed DateCitation Record Revised DateCitation Other SourceIDCitation Other Abstract TextCitation Other Abstract Text TypeCitation Other Abstract Text LanguageCitation Other Abstract Text Copyright InfoCitation Mesh Headings ListCitation Chemical Drug ListCitation Protocol Disease ListCitation Keywords ListCitation Number Of ReferencesCitation SubsetCitation Comments CorrectionsCitation Gene Symbol ListCitation Personal Name Subject ListCitation Space Flight MissionCitation Investigator ListCitation General NoteCitation Conflict Of Interest StatementJournal ISSNJournal ISSN TypeJournal TitleJournal Title ISO AbbreviationJournal Cited MediumJournal Volume IssueJournal Published DateJournal Published CountryJournal Title Standard AbbreviationJournal NLM IDJournal ISSN LinkingArticle TitleArticle AuthorsArticle LanguageArticle Publish ModelArticle Abstract TextArticle Abstract Text Copyright InfoArticle Publication TypesArticle PaginationArticle ELocationIDArticle DataBank ListArticle Grant ListArticle Vernacular TitleArticle Electronic Published DatePubMed HistoryPubMed Publication StatusPubMed ArticleID List
309131021MEDLINENLMCurated2020-09-082022-10-05D000328 Adult;MajorTopic D001011 Aorta;D021721 Balloon Occlusion;MajorTopic Q000379 methods;D002648 Child;D057510 Endovascular Procedures;Q000295 instrumentation;MajorTopic Q000379 methods;D005260 Female;D006801 Humans;MajorTopic D057446 Hydrodynamics;MajorTopic D008953 Models, Anatomic;D010372 Pediatrics;Q000295 instrumentation;Q000379 methods;D014057 Tomography, X-Ray ComputedIM1538-943XElectronicASAIO journal (American Society for Artificial Internal Organs : 1992)ASAIO JInternet66;12020-01United StatesASAIO J92041091058-2916Morphometric and Physiologic Modeling Study for Endovascular Occlusion in Pediatric Trauma Patients.Carrillo Louis From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;Skibber Max From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;Kumar Akshita From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;George Mitchell From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;Aziz Shahroz Department of Radiology, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;T Harting Matthew From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.;Moore Laura J Texas Trauma Institute, The University of Texas Health Science Center, Houston, Texas.;Cox Charles S Jr From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.engPrintThe use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) device is expanding in adult trauma. Reports of its use in pediatric patients have been published, but no guidelines currently exist nor has it been Food and Drug Administration approved in pediatrics. This project develops a model to determine appropriate balloon inflation volumes in pediatric patients to guide potential use. Artificial aortas were three-dimensional (3D) printed using synthetic polymers. Segments were created based on aortic diameters from 289 pediatric trauma patients' computer tomography (CT) scans. These aortic segments were inserted into a circulatory system model featuring two branches to simulate abdominal and upper body perfusion (cerebral, cardiac, and upper extremities). Sonographic flow meters and pressure transducers were placed along the circuit, and measurements were recorded as a REBOA device was inflated in the aortic segment. A negative sigmoidal relationship was observed between device inflation and aortic flow occlusion, with the initial 50% of inflation causing a 10% reduction in flow, followed by a steep decline. With increasing inflation, distal aortic flow and pressure were found to have an inverse relationship with the upper body branch metrics. In conclusion, pediatric patients present with a range of vessel diameters that occlude at various REBOA balloon inflation volumes. This study provides a basis to establish initial inflation volumes for safe REBOA deployment in appropriate pediatric trauma patients.D016428 Journal Article;D052061 Research Support, N.I.H., Extramural97-104doi 10.1097/MAT.0000000000000961T32 GM008792 GM NIGMS NIH HHS United Statespubmed 2019-3-27 6:0;medline 2020-9-9 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913102;doi 10.1097/MAT.0000000000000961;pmc PMC6856426;mid NIHMS1055902;pii 00002480-202001000-00016
309131031MEDLINENLMCurated2020-09-082022-10-05D000368 Aged;MajorTopic D002496 Central Venous Pressure;Q000502 physiology;D015331 Cohort Studies;MajorTopic D017097 Electric Impedance;D005260 Female;D006333 Heart Failure;Q000628 therapy;D006352 Heart Ventricles;Q000503 physiopathology;MajorTopic D006353 Heart-Assist Devices;D006439 Hemodynamics;Q000502 physiology;D006801 Humans;D008297 Male;MajorTopic D055641 Mathematical Concepts;D008875 Middle Aged;MajorTopic D010138 Pacemaker, ArtificialIM1538-943XElectronicASAIO journal (American Society for Artificial Internal Organs : 1992)ASAIO JInternet66;12020-01United StatesASAIO J92041091058-2916Estimation of Central Venous Pressure by Pacemaker Lead Impedances in Left Ventricular Assist Device Patients.Imamura Teruhiko From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Moss Joshua D From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Flatley Erin From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Rodgers Daniel From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Kim Gene From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Raikhelkar Jayant From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Sarswat Nitasha From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Kalantari Sara From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Nguyen Ann From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Juricek Colleen Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.;Burkhoff Daniel Columbia University Medical Center, and Cardiovascular Research Foundation, New York, New York.;Song Tae Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.;Ota Takeyoshi Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.;Jeevanandam Valluvan Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.;Sayer Gabriel From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.;Uriel Nir From the Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.engPrintVolume status assessment in left ventricular assist device (LVAD) patients remains challenging. Cardiac resynchronization therapy (CRT) devices are common in LVAD patients, and the impedance across the CRT leads may be associated with hemodynamics and serve as a tool for noninvasive estimation of volume status. Ninety-one sets of measurements including cardiac filling pressures and lead impedances were prospectively obtained during ramp tests from 11 LVAD patients (65.5 ± 9.7 years old; nine male) with CRT devices. Right atrial (RA), right ventricular (RV), and left ventricular (LV) lead impedances were all significantly associated with central venous pressure (CVP) (p < 0.05). We derived the following equation: estimated CVP = 47.90-(0.086 × RA lead impedance) + (0.013 × RV lead impedance)-(0.020 × LV lead impedance). The estimated CVP had a significant correlation (r = 0.795) and good agreement with the measured CVP (mean difference -0.14 ± 1.77 mmHg). Applying the above equation on the validation cohort of twenty-one patients also maintained a strong association with measured CVP (r = 0.705). In conclusion, we have derived a novel equation to estimate CVP using lead impedance measurements. This finding may allow noninvasive monitoring of volume status in LVAD patients.D016428 Journal Article;D052061 Research Support, N.I.H., Extramural;D013485 Research Support, Non-U.S. Gov't49-54doi 10.1097/MAT.0000000000000966T32 HL007381 HL NHLBI NIH HHS United Statespubmed 2019-3-27 6:0;medline 2020-9-9 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913103;doi 10.1097/MAT.0000000000000966;pmc PMC7081837;mid NIHMS1054911;pii 00002480-202001000-00008
309131041MEDLINENLMCurated2020-09-142021-01-25D000328 Adult;D005260 Female;D006333 Heart Failure;Q000276 immunology;MajorTopic Q000401 mortality;Q000628 therapy;D006353 Heart-Assist Devices;MajorTopic Q000009 adverse effects;D006801 Humans;D007249 Inflammation;Q000209 etiology;MajorTopic D008214 Lymphocytes;D008297 Male;D008875 Middle Aged;MajorTopic D009504 Neutrophils;D012189 Retrospective Studies;D013927 Thrombosis;MajorTopic Q000209 etiology;D016896 Treatment OutcomeIM1538-943XElectronicASAIO journal (American Society for Artificial Internal Organs : 1992)ASAIO JInternet66;22020-02United StatesASAIO J92041091058-2916Neutrophil to Lymphocyte Ratio Is Related to Thrombotic Complications and Survival in Continuous Flow Left Ventricular Assist Devices.Ferrera Carlos From the Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain.;Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Gonzalez Fernandez Oscar Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Bouzas Noelia Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Castrodeza Javier Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Green Thomas Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Woods Andrew Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Robinson-Smith Nicola Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Tovey Sian Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Jakovljevic Djordje G Institutes of Genetic Medicine and Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.;Shah Asif Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Booth Karen Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Parry Gareth Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Schueler Stephan Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;MacGowan Guy A Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.;Institutes of Genetic Medicine and Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.engPrintLeft ventricular assist devices (LVADs) have become an established treatment for advanced heart failure, although with long-term support these patients are potentially exposed to serious complications. Our purpose was to assess the role of the neutrophil to lymphocyte ratio (NLR) in LVAD complications and to evaluate if higher values of NLR after 4-6 months on LVAD support (NLR 4_6m) are associated with worse prognosis. All consecutive patients who received a HeartWare LVAD (N = 188, age 50 ± 13 years), as bridge to transplant from December 2009 to January 2018 were included. Neutrophil to lymphocyte ratio was recorded pre-LVAD, post-LVAD, after 4-6 months on support and in case of a first adverse event to occur after the 4-6 months NLR was recorded. Median NLR values were pre-LVAD 4.26 (interquartile range [IQR], 3.1-6.9), at 1 day postoperative 11.6 (IQR, 8.3-16.6), and NLR 4_6m 4.4 (IQR, 3.0-6.4) (p < 0.001). Neutrophil to lymphocyte ratio increased significantly when patients had an infection, stroke, or pump thrombosis, as compared with the NLR 4_6m (all p < 0.05). Patients with NLR 4_6m ≥ median had higher rates of stroke and mortality. Survival time was shorter among patients with NLR 4_6m ≥ 4.4 (log-rank test p = 0.006). Neutrophil to lymphocyte ratio 4_6m was found to be predictive of increased mortality (area under the curve of 0.62, p = 0.007). After multivariate analysis, NLR 4_6m remained independently associated with increased mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.03-2.7; p = 0.037). Neutrophil to lymphocyte ratio 4_6m values significantly increase in association with adverse events on LVAD support and are independently associated with mortality. This association suggests presence of inflammation adversely affects LVAD outcomes.D016428 Journal Article199-204doi 10.1097/MAT.0000000000000971pubmed 2019-3-27 6:0;medline 2020-9-15 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913104;doi 10.1097/MAT.0000000000000971;pii 00002480-202002000-00014
309131051MEDLINENLMAutomated2020-02-062020-12-09MajorTopic D000758 Anesthesia;MajorTopic D015199 Extracorporeal Membrane Oxygenation;D006801 Humans;MajorTopic D012128 Respiratory Distress Syndrome;D012189 Retrospective StudiesIMRefType:CommentOn ASAIO J. 2018 Jul/Aug;64(4):544-551 29045280 ;RefType:CommentOn ASAIO J. 2019 May/Jun;65(4):e44-e45 30913098 1538-943XElectronicASAIO journal (American Society for Artificial Internal Organs : 1992)ASAIO JInternet65;4United StatesASAIO J92041091058-2916Individualizing and Minimizing Sedation on Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Patients, a Reply.deBacker Julian Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Medicine and Interdepartmental Division of Critical Care Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.;Fan Eddy;Mehta SangeetaengPrintD016422 Letter;D016420 Commente46doi 10.1097/MAT.0000000000000970pubmed 2019-3-27 6:0;medline 2020-2-7 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913105;doi 10.1097/MAT.0000000000000970
309131071MEDLINENLMCurated2020-09-142021-01-25D000925 Anticoagulants;Q000627 therapeutic use;D000991 Antithrombins;Q000627 therapeutic use;D001777 Blood Coagulation;Q000187 drug effects;MajorTopic D001780 Blood Coagulation Tests;D015199 Extracorporeal Membrane Oxygenation;MajorTopic Q000009 adverse effects;D005260 Female;D006470 Hemorrhage;Q000209 etiology;Q000517 prevention & control;D006487 Hemostasis;D006801 Humans;D008297 Male;MajorTopic D013927 Thrombosis;Q000209 etiology;Q000517 prevention & control0 D000925 Anticoagulants;0 D000991 AntithrombinsIM1538-943XElectronicASAIO journal (American Society for Artificial Internal Organs : 1992)ASAIO JInternet66;22020-02United StatesASAIO J92041091058-2916Monitoring Hemostasis During Extracorporeal Life Support.Saifee Nabiha H From the Department of Laboratory Medicine, BloodWorks Northwest, Seattle, Washington.;Department of Laboratory Medicine, University of Washington, Seattle, Washington.;Brogan Thomas V Seattle Children's Hospital, Seattle, Washington.;Department of Pediatrics, University of Washington, Seattle, Washington.;McMullan David M Department of Laboratory Medicine, University of Washington, Seattle, Washington.;Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.;Yalon Larissa Seattle Children's Hospital, Seattle, Washington.;Matthews Dana C Seattle Children's Hospital, Seattle, Washington.;Division of Hematology and Oncology, Department of Pediatrics, University of Washington, Seattle, Washington.;Burke Christopher R Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.;Chandler Wayne L Department of Laboratory Medicine, University of Washington, Seattle, Washington.;Seattle Children's Hospital, Seattle, Washington.engPrintTo balance the risk of bleeding versus circuit thrombosis during extracorporeal life support (ECLS), it is important to monitor anticoagulants and hemostasis. We evaluated the prothrombin time (PT), partial thromboplastin time (PTT), activated clotting time (ACT), and antifactor Xa heparin activity (aXa) correlation with changes in coagulation factor and heparin levels using in vitro and in vivo samples. aXa correlated with heparin (r = 0.97) and antithrombin (r = 0.98) but was unaffected by other parameters. PT correlated with coagulation factors (r = 0.88) but was minimally affected by heparin or other parameters. When single parameters were changed, ACT was insensitive to <0.5 U/ml heparin, correlated with coagulation factors (r = 0.99), and was affected by factor XII and platelets. When multiple parameters changed in vitro and in vivo, ACT was not correlated with heparin or coagulation factors. PTT correlated with heparin and coagulation factors individually but had low correlation when multiple parameters changed in vitro and in vivo. In conclusion, aXa is the most specific for heparin levels, and PT is most specific for coagulation factor levels making these assays well suited to monitor anticoagulation and hemostasis for patients on ECLS. PTT is highly variable when multiple parameters are changing in vitro and in vivo, but may be useful when aXa cannot be used because of interference. ACT is too insensitive to heparin, sensitive to too many other factors, and too imprecise to be useful for monitoring hemostasis during ECLS.D016428 Journal Article230-237doi 10.1097/MAT.0000000000000993pubmed 2019-3-27 6:0;medline 2020-9-15 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913107;doi 10.1097/MAT.0000000000000993;pii 00002480-202002000-00019
309131081MEDLINENLMAutomated2019-10-292019-10-29D003442 Crowns;D006801 Humans;MajorTopic D057873 Peri-Implantitis;D011446 Prospective Studies;D012189 Retrospective Studies;D012307 Risk Factors1538-2982ElectronicImplant dentistryImplant DentInternet28;22019-AprUnited StatesImplant Dent92064811056-6163Periimplant Disease and Prosthetic Risk Indicators: A Literature Review.Serino Giovanni Head of Department of Periodontology, Specialist in Periodontology, Specialist Clinics, Public Dental Service, Södra Älvsborg Hospital, Borås, Sweden.;Hultin Kristina Specialist in Prosthodontics, Department of Prosthodontics, Specialist Clinics, Public Dental Service, Södra Älvsborg Hospital, Borås, Sweden.engPrintPURPOSE OBJECTIVE The purpose of this review was to search in international published peer-review articles, data regarding prosthetic risk indicators affecting the incidence, prevalence, or treatment outcome of periimplant diseases.;MATERIALS AND METHODS METHODS A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine of articles published until February 2018; a manual search was also added. Randomized controlled trials, controlled trials, prospective and retrospective cohort studies with a minimum of 20 subjects, having cases with/without exposure to the risk indicator were included. Articles written in another language than English were not included.;RESULTS RESULTS The 17 articles reviewed indicated the cement residuals at abutments were identified as risk factors for both mucositis and periimplantitis. Among the screw-retained prosthetic reconstructions, prostheses screwed directly to the implants have higher risk to develop periimplant disease. The accessibility and the possibility to perform adequate plaque control around the prosthetic suprastructure decreases the risk for periimplant disease; convex emergence profiles seem to increase it. The crown margins located submucosa may impair the periimplant treatment outcome.;CONCLUSION CONCLUSIONS Prosthetic reconstruction on implants should be designed in a way to allow accessibility to proper plaque control. Screw-retained suprastructure and crown margins located supra-mucosa should be preferred when possible. When using cement-retained suprastructure, attention should be given to remove cement residuals.D016428 Journal Article;D016454 Review125-137doi 10.1097/ID.0000000000000841entrez 2019-3-27 6:0;pubmed 2019-3-27 6:0;medline 2019-10-30 6:0ppublishpubmed 30913108;doi 10.1097/ID.0000000000000841;pii 00008505-201904000-00006
309131091MEDLINENLMCurated2019-10-292022-05-31MajorTopic D015921 Dental Implants;D006801 Humans;MajorTopic D057873 Peri-Implantitis;MajorTopic D013280 Stomatitis0 D015921 Dental Implants1538-2982ElectronicImplant dentistryImplant DentInternet28;22019-AprUnited StatesImplant Dent92064811056-6163Soft-Tissue Conditions Around Dental Implants: A Literature Review.Lin Guo-Hao Assistant Clinical Professor, Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA.;Madi Iman M Private Practitioner, South County Periodontics & Implant Dentistry, Mission Viejo, CA.engPrintBACKGROUND BACKGROUND The aim of this article is to review the current understanding regarding periimplant soft-tissue conditions to minimize risk of periimplant mucositis and periimplantitis.;MATERIALS AND METHODS METHODS An electronic search was performed in 4 different databases. Articles were reviewed and summarized if the following criteria were met: published evidence with recommendations on soft-tissue conditions around dental implants.;RESULTS RESULTS An evaluation of various soft-tissue parameters, including the need of keratinized mucosa, periimplant mucosal height and phenotype, midfacial tissue level, and papillary fill, was performed based on the currently available evidence.;COMMENTS CONCLUSIONS The need of keratinized mucosa is the parameter investigated the most. A trend favors a need of a wide band of nonmobile keratinized mucosa is seen with the benefit of less incidence of periimplant mucositis. In addition, the influence of the mucosal height and tissue phenotype on periimplant tissue health remains inconclusive. Although other soft-tissue parameters, including papillary fill and midfacial tissue level, are not yet proven to be related to periimplantitis, they play a crucial role to achieve successful esthetics.;CONCLUSION CONCLUSIONS A limited amount of evidence was identified to correlate periimplant soft-tissue parameters with periimplantitis. However, a wide band of nonmobile keratinized mucosa, an adequate periimplant mucosal height, and a thick tissue phenotype might reduce the incidence of tissue inflammation and future complications.D016428 Journal Article;D016454 Review138-143doi 10.1097/ID.0000000000000871entrez 2019-3-27 6:0;pubmed 2019-3-27 6:0;medline 2019-10-30 6:0ppublishpubmed 30913109;doi 10.1097/ID.0000000000000871;pii 00008505-201904000-00007
309131101MEDLINENLMAutomated2019-10-292019-10-29D006801 Humans;MajorTopic D052016 Mucositis;D009910 Oral Hygiene;MajorTopic D057873 Peri-Implantitis;D019736 Prostheses and Implants;MajorTopic D013280 Stomatitis1538-2982ElectronicImplant dentistryImplant DentInternet28;22019-AprUnited StatesImplant Dent92064811056-6163Treatment Planning for Periimplant Mucositis and Periimplantitis.Polyzois Ioannis Associate Professor\Consultant in Periodontology, Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland.engPrintPURPOSE OBJECTIVE A literature search was performed in a number of health care databases for articles published until January 2018.;DISCUSSION CONCLUSIONS A number of anatomical factors, risk indicators, possible aesthetic complications, and financial implications have to be taken into consideration before treatment commences. When diagnosed early, periimplant mucositis is a problem that can be easily managed as long as the patient is motivated and maintains good levels of oral hygiene. Periimplantitis is more difficult to treat and results can be unpredictable. Nonsurgical therapy has limited effectiveness on the treatment of periimplantitis, but it should always precede a surgical intervention. Clinically predictable surgical outcomes seem to rely mainly on the configuration of the bone defect, the position of the affected implant, and the patient's ability to perform good oral hygiene.;CONCLUSIONS CONCLUSIONS Thorough treatment planning of periimplant diseases is paramount for the success of the treatment that follows. Local and general factors as well as patients' expectations have to be considered before proceeding, but treatment planning should also allow for a degree of flexibility, which will accommodate the unknown parameters.D016428 Journal Article150-154doi 10.1097/ID.0000000000000869entrez 2019-3-27 6:0;pubmed 2019-3-27 6:0;medline 2019-10-30 6:0ppublishpubmed 30913110;doi 10.1097/ID.0000000000000869;pii 00008505-201904000-00009
309131111MEDLINENLMAutomated2019-10-292019-10-29D000900 Anti-Bacterial Agents;MajorTopic D000890 Anti-Infective Agents;D003131 Combined Modality Therapy;D006801 Humans;MajorTopic D053685 Laser Therapy;MajorTopic D057873 Peri-Implantitis0 D000900 Anti-Bacterial Agents;0 D000890 Anti-Infective Agents1538-2982ElectronicImplant dentistryImplant DentInternet28;22019-AprUnited StatesImplant Dent92064811056-6163Nonsurgical Treatment of Periimplantitis.Wang Chin-Wei Clinical Assistant Professor and Director of Predoctoral Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.;Renvert Stefan Professor and Research Director, Oral Health Sciences, Kristianstad University School of Dentistry, Kristianstad, Sweden Visiting Professor, School of Dental Science, Trinity College, Dublin, Ireland.;Wang Hom-Lay Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.engPrintPURPOSE OBJECTIVE Periimplantitis has become an emerging challenge faced by practicing dentists worldwide. When treating periimplantitis, we should attempt to manage this problem via nonsurgical therapies that include addressing all modifiable systemic risk factors and local contributing factors. Hence, the aim of this narrative review was to examine published studies on nonsurgical treatment of periimplantitis and evaluate their effectiveness and limitations.;MATERIALS AND METHODS METHODS A literature search was performed in MEDLINE via PubMed database up to December 31, 2017. Current published clinical approaches focused on mechanical debridement, adjunctive antiseptic therapy, adjunctive antibiotic therapy, laser-assisted therapy, and combination approaches were included in this analysis.;RESULTS RESULTS Nonsurgical therapy of periimplantitis may result in complete healing of the disease and the patient is then placed on a supportive maintenance program. If the disease is not resolved and surgical intervention is not an option, active nonsurgical retreatment may be considered. In many cases where disease is not resolved, surgical therapy or implant removal could be considered.;CONCLUSIONS CONCLUSIONS Nonsurgical treatment of periimplantitis usually provides clinical improvements in reducing bleeding tendency and in some cases pocket reduction. Early diagnosis, detection, and intervention remain the key for managing periimplantitis.D016428 Journal Article;D016454 Review155-160doi 10.1097/ID.0000000000000846entrez 2019-3-27 6:0;pubmed 2019-3-27 6:0;medline 2019-10-30 6:0ppublishpubmed 30913111;doi 10.1097/ID.0000000000000846;pii 00008505-201904000-00010
309131121MEDLINENLM2020-04-152020-07-01D000328 Adult;D000368 Aged;D001170 Arthritis, Infectious;MajorTopic Q000150 complications;D019643 Arthroplasty, Replacement;MajorTopic Q000009 adverse effects;D015331 Cohort Studies;D005260 Female;D006801 Humans;D007595 Joint Prosthesis;MajorTopic Q000009 adverse effects;D053208 Kaplan-Meier Estimate;D008297 Male;D008875 Middle Aged;D016016 Proportional Hazards Models;D016459 Prosthesis-Related Infections;MajorTopic Q000209 etiology;D012189 Retrospective Studies;D012307 Risk FactorsIMRefType:CommentIn Clin Orthop Relat Res. 2019 Jul;477(7):1613-1614 31107320 1528-1132ElectronicClinical orthopaedics and related researchClin Orthop Relat ResInternet477;72019-07United StatesClin Orthop Relat Res756740009-921XPatients with a History of Treated Septic Arthritis are at High Risk of Periprosthetic Joint Infection after Total Joint Arthroplasty.Sultan Assem A A. A. Sultan, B. Mahmood, L. T. Samuel, J. George, M. Faour, A. K. Klika, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA C. E. Pelt, M. B. Anderson, Department of Orthopaedic Surgery, Utah University Medical Center, Salt Lake City, UT, USA C. A. Higuera, Department of Orthopaedic Surgery, Cleveland Clinic, Weston, FL, USA.;Mahmood Bilal;Samuel Linsen T;George Jaiben;Faour Mhamad;Pelt Christopher E;Anderson Mike B;Klika Alison K;Higuera Carlos AengPrintBACKGROUND In patients undergoing total joint arthroplasty (TJA), increasing attention has been directed recently toward identifying specific patient-related risk factors that may predispose patients to periprosthetic joint infection (PJI). Currently, it is unclear whether having a history of a treated native septic arthritis is a risk factor for PJI after TJA in the same joint. Previous studies have reported contradictory evidence and results varied between a substantially higher rates of PJIs to very low or no reported PJIs.;QUESTIONS/PURPOSES (1) What is the risk of PJI in patients who received TJA and had a history of treated same-joint native joint septic arthritis and (2) What are the associated risk factors for these patients developing PJI?;METHODS This was a multicenter retrospective analysis of patients who received primary THA or TKA between January 2000 and December 2016 and who had a history of treated native joint septic arthritis in the same joint. Patients were included in the study only if they were considered to have resolved their joint infection based on a preoperative evaluation that included: (1) the absence of clinical symptoms and signs of active infection or local joint inflammation, (2) recent plain radiographs showing only advanced degenerative changes without evidence of active osteolysis or bone infection, (3) preoperative laboratory investigations for infection, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total leukocyte counts within normal ranges. Patients were reviewed for the occurrence of postoperative PJI. The final cohort included 62 patients who had a mean followup of 4.4 years (range, 3 months-17 years) from the time of TJA. A total of 21 patients (34%) had less than 2 years of followup, including six (10%) mortalities. In total, eight patients (13%) died during the study period, none of which were due to PJI. Patient characteristics, time interval from treatment of septic arthritis to TJA, and Charlson comorbidity index adjusted for age were collected. We used a Kaplan-Meier analysis to estimate the overall survivorship among all TJAs as well as those who underwent THA versus TKA, and we performed a statistical comparison using the Mantel-Cox log-rank test. We performed a Cox regression hazard ratio (HR) survival analysis to identify risk factors for PJI. The PJI odds ratios (OR) for patients who underwent TJA within 2 years of septic arthritis were calculated as an additional temporal analysis.;RESULTS In patients with a history of treated same-joint native septic arthritis, the proportion of PJI was five of 62 patients (8%). The Kaplan-Meier analysis demonstrated an overall survivorship free from PJI of 92% at 14.5 ± 1.14 years (95% confidence interval [CI] = 12.3-16.8 years). All PJI cases occurred only in patients who underwent TKA, which when analyzed separately, yielded a survivorship of 85% at 10.5 ± 0.9 years (95% CI = 8.7-12.3 years) versus 100% in patients who underwent THA (p = 0.068). Mean time to PJI occurrence was 10 months (range, 2-20 months). After controlling for relevant confounding variables, such as age, sex, affected joint and comorbidities, we found smoking (HR, 8.06; 95% CI, 1.33-48.67; p = 0.023) to be associated with increased risk for PJI development.;CONCLUSION Patients with history of native joint infections are at higher risk of PJI, especially smokers. Despite our limitations, this study suggests careful assessment of several other factors in these patients, including allowing a minimum interval of 2 years from the time of resolving native joint septic arthritis to TJA. Patients who are undergoing TKA seem to be more prone to the PJI risk and may benefit from more aggressive planning. In addition, medical optimization of comorbidities that may confer additional risk, such as diabetes, become exceptionally important in these patients.;LEVEL OF EVIDENCE Level III, therapeutic study.D016428 Journal Article;D016448 Multicenter Study1605-1612doi 10.1097/CORR.0000000000000688pubmed 2019-3-27 6:0;medline 2020-4-16 6:0;entrez 2019-3-27 6:0ppublishpubmed 30913112;doi 10.1097/CORR.0000000000000688;pmc PMC6999997