lhcqf logo 2016


Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science


Sertoli cell differentiation is induced both cell-autonomously and through prostaglandin signaling during mammalian sex determination discount 300mg eskalith. Antagonism of the testis and ovary-determining pathways during ovotestis development in mice discount eskalith 300 mg visa. Spatiotemporal cell expression of luteinizing hormone-releasing hormone in the prenatal mouse: evidence for an embryonic origin in the olfactory placode cheap generic eskalith uk. Octa-guanidine morpholino restores dystrophin expression in cardiac and skeletal muscles and ameliorates pathology in dystrophic mdx mice. Uncovering novel reproductive defects in neurokinin B receptor null mice: closing the gap between mice and men. Cell adhesion events mediated by alpha 4 integrins are essential in placental and cardiac development. Disruption of testis cords by cyclopamine or forskolin reveals independent cellular pathways in testis organogenesis. Sexually dimorphic regulation of inhibin beta B in establishing gonadal vasculature in mice. Desert Hedgehog/Patched 1 signaling specifies fetal Leydig cell fate in testis organogenesis. Gene expression profiling of early follicular development in primordial, primary, and secondary follicles. Two classes of ovarian primordial follicles exhibit distinct developmental dynamics and physiological functions. Gene Catalogue Code Gene Catalogue Code Adamts 16 Mm00468144 m1 Nr5a1 (Sf1) Mm00446826 m1 Adamts19 Mm00558559 m1 Pax6 Mm00443081 m1 Adcy7 Mm00545780 m1 Pdx1 Mm00435565 m1 Amh Mm03023963 m1 Pdzk1 Mm00451926 m1 Arx Mm00545903 m1 Pou5f1 (Oct3/4) Mm00658129 gH Car2 Mm00501576 m1 Ppy Mm00435889 m1 Cdh1 (E-cad) Mm01247357 m1 Prlr Mm04336676 m1 Clca1 Mm00777368 m1 Ptch1 Mm00436026 m1 Cyp11a1 (Scc) Mm00490735 m1 Ptgds Mm01330613 m1 Ddx4 (Mvh) Mm00802445 m1 Rec8 Mm00490939 m1 Dhh Mm01310203 m1 Robo2 Mm00620713 m1 Dmc1 Mm00494485 m1 Rspo1 Mm00507076 m1 FoxL2 Mm00843544 s1 Scp3 Mm00488519 m1 Fras1 Mm00663578 m1 Sox18 Mm00656049 gH Frem2 Mm00556222 m1 Sox9 Mm00448840 m1 Fst Mm00514982 m1 Sst Mm00436671 m1 Ghrl Mm00445450 m1 Star Mm00441558 m1 Glug Mm00801712 m1 Stra8 Mm00486473 m1 Gstm7 Mm00499573 g1 Tac2 Mm01160362 m1 Hsd3b Mm01261921 mH Tacr3 Mm00445346 m1 Ins1 Mm01950294 s1 Tbp* Mm00446973 m1 Ins2 Mm00731595 gH Trank1 Mm01245649 m1 Irx3 Mm00500463 m1 Wnt4 Mm00437341 m1 Mc2r Mm00434865 s1 Wt1 Mm01337048 m1 Notch2 Mm00803077 m1 Xlr3 Mm00496001 m1 Nr0b1 (Dax1) Mm00431729 m1 199 Supplemental Table 3: Primary Antibodies for Immunofluorescence and Western Blot Dilutions and catalogue numbers for primary antibodies described in this thesis. Braces, "", indicate mutations that contribute to susceptibility to multifactorial disorders. The number in parentheses after the name of each disorder indicates the following: (1) the disorder was positioned by mapping of the wildtype gene; (2) the disease phenotype itself was mapped; (3) the molecular basis of the disorder is known; (4) the disorder is a chromosome deletion or duplication syndrome. The first digit of the number provides the following information summarized below: 1- (100000) 2- (200000) Autosomal loci or phenotypes (entries created before May 15, 1994) 3- (300000) X-linked loci or phenotypes 4- (400000) Y-linked loci or phenotypes 5- (500000) Mitochondrial loci or phenotypes 6- (600000) Autosomal loci or phenotypes (entries created after May 15, 1994) 205 Supplemental Table 8. This video demonstrates the injection of a construct (marked by blue dye) into the left ventricle of the beating embryo heart at 11. After injection the embryo is incubated with the heart still beating for 30 min before dissection for organ culture. Only genes with at least 1 count per million in three or more samples were retained (features= 14,307). The counts for a transcript can be graphed using this data file in the “graph cpm” sheet. This workbook contains the genes that were upregulated in each enriched cell population. Exp (supporting) show median normalised expression of the gene in each of these two cell types, while Int. Wainwright, Josephine Bowles*, Peter Koopman Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia * j. Koopman P (2015) Rapid Screening of Gene We also generated a novel double knockdown of Gli1 and Gli2, revealing defects in Leydig Function by Systemic Delivery of Morpholino Oligonucleotides to Live Mouse Embryos. Academic Editor: Michael Schubert, Laboratoire de these studies reveal the utility of this method as a means of first-pass analysis of gene func Biologie du Developpement de Villefranche-sur-Mer, tion during organogenesis before committing to detailed genetic analysis. This is an open One of the central challenges in the era of functional genomics is to understand gene function access article distributed under the terms of the and unravel the complex networks in which proteins operate to determine phenotype. Moreover, it is often the case that, after investing the time and resources required that no competing interests exist. Typical ly, these approaches have caused damage to the target tissue as well as being limited in delivery area. We aimed to develop a method whereby gene function could be perturbed ex vivo, rapidly and without injury to the target organ. We demonstrate knockdown of protein expres sion for a number of target genes, leading to predicted downstream effects for known genes and novel functional insights for other genes or combinations of genes. This method offers a rapid, reproducible, efficient means of rapidly pre-screening gene candidates for likely func tion, as a prelude to more rigorous functional studies in mice. Embryos with non-beating or weakly beating hearts, or where injection was unsuccessful as judged by lack of circulation of the dye (about 1 in 15 em bryos), were excluded from further study. Dye can be visualised going around the embryonic vasculature (indicated by white arrows) (C, D) and into the head vasculature (D) before the whole embryo is coloured (E). Schematic of ventricle injection (F) and the embryonic gonad which is highly vascularised (G). For pancreas culture, the foregut endoderm was isolated and any non-affiliated organs re moved. Immunofluorescence Analyses were carried out on fixed, paraffin-embedded 7 m sections using standard methods. Briefly, gonad plus mesonephros complexes or foreguts were fixed in 4% paraformaldehyde in phosphate buffered saline overnight at 4°C. Slides were dewaxed by 2 x 10 min washes in xylene, re hydrated and boiled for 5 min in Anti gen Unmasking Solution (Vector Laboratories), then incubated at room temperature for 60 min. The sections were incubated with primary antibodies, which were diluted in blocking buffer at 4°C overnight (for primary antibodies see S3 Table).

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Fi cephalic bres go into or out of the cerebellum through cephalic /s f l k/ adjective referring to best eskalith 300 mg the the peduncles discount eskalith 300 mg visa. The cerebellum is the part of head the brain where voluntary movements are co cephalic index cephalic index /s f l k ndeks/ noun a ordinated and is associated with the sense of measurement of the shape of the skull balance purchase genuine eskalith on-line. Also called aqueduct cephalocele of Sylvius cephalocele / sef l si l/ noun a swelling cerebral artery caused by part of the brain passing through a cerebral artery / ser br l t ri/ noun one weak point in the bones of the skull of the main arteries which take blood into the cephalogram brain cephalogram / sef l &r m/ noun an X cerebral cavity ray photograph of the bones of the skull cerebral cavity /ser br l k v ti/ noun cephalometry one of the four connected fluid-filled spaces in cephalometry /sef l m tri/ noun meas urement of the head the brain cephalopelvic cerebral cortex cephalopelvic /sef l pelv k/ adjective cerebral cortex /ser br l k teks/ noun referring to the head of the fetus and the pelvis the outer layer of grey matter which covers the of the mother cerebrum cephalopelvic disproportion cerebral decompression cephalopelvic disproportion /sef l cerebral decompression /ser br l pelv k d spr p n/ noun a condition in di k m pre n/ noun the removal of part of which the pelvic opening of the mother is not the skull to relieve pressure on the brain large enough for the head of the fetus cerebral dominance cephalosporin cerebral dominance /ser br l d m n ns/ cephalosporin /sef l sp r n/ noun a noun the usual condition where the centres for drug used in the treatment of bacterial infec various functions are located in one cerebral tion hemisphere 67 cervical plexus cerebral haemorrhage cerebral haemorrhage /ser br l blocking of or bleeding from a blood vessel in hemr d / noun bleeding inside the brain the brain resulting in temporary or permanent from a cerebral artery. Also called stroke orrhage cerebrovascular disease cerebral hemisphere cerebrovascular disease /ser br cerebral hemisphere /ser br l hem s* v skj l d zi z/ noun a disease of the blood f / noun one of the two halves of the cere vessels in the brain brum cerebrum cerebral infarction cerebrum /s ri br m/ noun the largest part cerebral infarction /ser br l n f k n/ of the brain, formed of two sections, the cere noun the death of brain tissue as a result of re bral hemispheres, which run along the length duction in the blood supply to the brain of the head. The cerebrum controls the main cerebral ischaemia mental processes, including the memory. Also cerebral ischaemia /ser br l ski mi / noun failure in the blood supply to the brain called telencephalon cerebral palsy certificate cerebral palsy /ser br l p lzi/ noun a certificate /s t f k t/ noun an official paper disorder mainly due to brain damage occurring which states something before birth, or due to lack of oxygen during certify certify / s!. Also called cer cerebro cerebro /ser br / prefix referring to the vicouterine canal cerebrum cervical cancer cerebrospinal cervical cancer / s!. It consists noun one of the bundles of nerves in the neck mainly of water, with some sugar and sodium cervical incompetence cervical incompetence /s!. Its function is to cushion the brain nk mp tns/ noun a dysfunction of the and spinal cord and it is continually formed and absorbed to maintain the correct pres cervix of the uterus which is often the cause of sure. After Jean-Martin America, transmitted by insect bites which Charcot (1825–93), French neurologist. Chil Charcot’s triad / k z tra d/ noun dren are mainly affected and if untreated the three symptoms of multiple sclerosis: rapid disease can cause fatal heart block in early eye movement, tremor and scanning speech charleyhorse adult life. The tablets are sold at all chem shown as a series of lines or points on graph ists. In later life, shingles is usually a re restr nt s ndr m/ noun an allergic con emergence of a dormant chickenpox virus dition which gives people severe headaches af and an adult with shingles can infect a child ter eating food flavoured with monosodium with chickenpox. Also called erythema pernio son who treats musculoskeletal disorders by child child /t a ld/ noun a young boy or girl. Child making adjustments primarily to the bones of is the legal term for a person under 14 years of the spine age. For other chiropracty chiropracty / ka r pr kti/ noun same as terms referring to children, see words beginning chiropractic (informal) with paed-, paedo or ped-, pedo-. It is currently a ma childbearing childbearing / t a ldbe r / noun the act of jor cause of sexually transmitted disease. Also called parturition chloasma child care chloasma /kl zm / noun the presence of child care / t a ld ke / noun the care of brown spots on the skin from various causes young children and study of their special needs chlor child health clinic chlor /kl r/ prefix same as chloro (used be child health clinic /t a ld hel kl n k/ fore vowels) noun a special clinic for checking the health chlorambucil chlorambucil /kl r mbj s l/ noun a drug and development of small children under which is toxic to cells, used in cancer treat school age. It stimulates the gall bladder, treatment of diabetes making it contract and release bile. The disease is often fatal and vacci chondromalacia nation is only effective for a relatively short pe chondromalacia /k ndr m le / noun riod. High pain levels of cholesterol in the blood are found in chorea chorea /k ri / noun a sudden severe diabetes. Cholesterol is formed by the body, twitching, usually of the face and shoulders, and high blood cholesterol levels are associ which is a symptom of disease of the nervous ated with diets rich in animal fat, such as but ter and fat meat. Excess cholesterol can be system chorion deposited in the walls of arteries, causing chorion / k ri n/ noun a membrane cover atherosclerosis. Now called chronic obstructive chromic acid chromic acid / kr m k s d/ noun an un pulmonary disease stable acid existing only in solution or in the chronic obstructive pulmonary disease chronic obstructive pulmonary disease form of a salt, sometimes used in the removal / kr n k b str"kt v p"lm nri d zi z/ of warts noun any of a group of progressive respiratory chromicised catgut chromicised catgut /kr m sa zd disorders where someone experiences loss of k t&"t/ noun catgut which is hardened with lung function and shows little or no response chromium to make it slower to dissolve in the to steroid or bronchodilator drug treatments, body. If a Y chromosome sperm fertilises the which provides benefits such as alterations to female’s ovum the child will be male. After ciliary muscle ciliary muscle / s li ri m"sl/ noun a Thomas Willis (1621–75), English physician and muscle which makes the lens of the eye change anatomist. Rub your hands to get the circu many tiny hair-like processes which line cells lation going. The capillaries exchange -cillin /s l n/ suffix used in the names of peni cillin drugs amoxycillin the oxygen for waste matter such as carbon cimetidine dioxide which is taken back to the lungs to be cimetidine /s met di n/ noun a drug which expelled. At the same time the blood obtains reduces the production of stomach acid, used more oxygen in the lungs to be taken to the in peptic ulcer treatment tissues. The circulation pattern is as follows: cimex blood returns through the veins to the right cimex / sa meks/ noun a bedbug or related atrium of the heart. It can also ing progressively more difficult and finally im be caused by heart disease (cardiac cirrho possible. Compare agoraphobia cirrhotic claustrophobic cirrhotic /s r t k/ adjective referring to cir claustrophobic / kl str f b k/ adjective rhosis the patient had a cirrhotic liver. It is used in the treatment of ovarian claw foot / kl f t/ noun a deformed foot and testicular cancer. He is on clear up 76 antibiotics to try to clear the congestion in his ‘we studied 69 patients who met the clinical and lungs. Also develop a strategy to raise the quality of medi called harelip cal care cleft palate cleft palate / kleft p l t/ noun a congenital clinically condition in which the palate does not fuse clinically / kl n kli/ adverb using information during fetal development, causing a gap be gathered from the treatment of patients in a tween the mouth and nasal cavity in severe hospital ward or in the doctor’s surgery cases Smallpox is now clinically extinct. Both can be successfully cor medsn/ noun the study and treatment of rected by surgery. Also called coagulation time aorta congenital narrowing of the aorta, which cloud cloud /kla d/ noun the disturbed sediment in results in high blood pressure in the upper part a liquid of the body and low blood pressure in the low cloudy er part cloudy / kla di/ adjective referring to liquid coarse tremor which is not transparent but which has an coarse tremor /k s trem / noun severe opaque substance in it trembling coat 78 coat coat /k t/ noun a layer of material covering information 2. Also coeliac disease coeliac disease /si li k d zi z/ noun called coccygodynia same as gluten-induced enteropathy coccygeal vertebrae coeliac ganglion coccygeal vertebrae /k k s d i l v!. Also called enteralgia, tormi cognitive therapy / k &n t v er pi/ noun a treatment of psychiatric disorders such as na 2. A snow good collateral blood supply makes occlusion of a cold compress single branch of the coeliac axis safe. The cles of one substance dispersed in another sub commonest form is the inability to tell the dif stance 2.

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Digital sensors will be secured by the clinic staffs order eskalith 300mg with amex, and will be issued to eskalith 300mg with amex students only when a prescription for specific radiographs has been signed by a licensed dentist order eskalith 300 mg overnight delivery. Radiographic viewing should be accomplished under ideal conditions with equipment such as dim background lighting, masked viewboxes of adequate and uniform intensity, opaque film mounts and magnifying glasses. For viewing digital radiographs, the monitors should preferably housed in a dimly lit area. For diagnosis purpose, the images preferably should be viewed on a computer screen instead of a print. All radiographs shall be prescribed in writing on the Radiographic Request form or in axiUm and signed/digitally signed by a licensed dentist. The request must include clearly stated reason for the examination, prior to the procedure being done and entered in the Progress Notes sheet or in axiUm. Radiographs for all patients shall be ordered only after clinical examination to determine the need and desirability of specific radiographs. Radiographs ordered merely on the basis of routine or for screening purposes shall not be permitted. The limits on exposure in each case will be determined by the professional judgment of a faculty dentist. The procedure to be employed and the frequency of the examination shall be determined by the professional judgment of the dentist ordering the radiographs. If prior radiographs are available from a private dentist or another institution, they must be evaluated before new radiographs are prescribed. Only those additional views needed to complete diagnosis and treatment planning shall be exposed. This requirement does not preclude making a new complete intraoral survey if it is appropriate to the diagnosis. Radiographs obtained for administrative purposes only, including those for insurance claims or legal proceedings, should not be made. However, diagnostic radiographs already made may be used for administrative purposes. Demonstrations or training on X-ray equipment must be performed with proper protection of the observers and operator(s). Deliberate exposure of an individual to radiographic procedure for training or demonstration purposes shall not be permitted, unless there is a diagnostic need for the exposure. Individuals exposed for other than diagnostic reasons shall have the approval of the Human Use Subcommittee and All-University Radiation Protection Committee of the University of Minnesota. Students should be assisted with all patients requiring three or more retake radiographs on a complete intraoral radiograph survey. A minimally acceptable complete mouth radiographic survey should demonstrate, at least one time, each tooth in entirety and each interproximal space without overlapping and with clarity and accuracy. Discretionary radiographic examination of patients who are known to be pregnant should be delayed until after delivery. No individual under 18 years of age shall be allowed to receive any occupational radiation dose except for training purposes. For film based radiography, only American National Standards Institute Speed Group E film or faster. For introral radiography, rectangular collimation should be achieved, either by using a rectangular tube or a rectangular collimation. The hands and body of the assisting person should be positioned in a manner to prevent primary beam exposure, and a protective lead apron and gloves of 0. During each exposure, the operator shall stand behind the barrier provided for each operatory. Leaded rubber aprons and thyroid shields shall be used for all intra-oral procedures as an additional precaution to minimize scatter radiation exposure to the body of the patient. The patient should be observed through a lead-glass window, if possible, during each exposure. The operator must review the history of previous patient exposure and status in regard to any infectious disease. If a malfunction is detected in an X-ray machine, it should be corrected immediately or the machine shall be "closed down" until the necessary corrections have been made and the equipment recalibrated. Mechanical support of the tube head and cone shall maintain the exposure position without drift or vibration. Intraoral film/sensor holding devices must be used except when endodontic procedures do not permit doing so. In those cases where the patient must hold the extraoral film cassette, the patient must wear 0. In addition, any portion of the body, other than the area of interest must be covered by 0. Extra-oral exposures should employ screen-film combinations of the highest speed consistent with their diagnostic objectives. Direct exposure X-ray film (without intensifying screens in a cassette) shall not be permitted for extraoral radiography. Intra-oral fluoroscopy shall not be used for intra-oral radiographic examinations. All intra-oral X-ray machines shall be equipped with open-ended, shielded cones limiting the beam Page | 187 diameter to 2.

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Routine varicella immunization has drastically reduced the incidence of this infection order eskalith now. Subsequently cheap eskalith 300 mg without a prescription, a pruritic 300mg eskalith mastercard, vesicular rash originates on the scalp or trunk and spreads to the rest of the body. The lesions of varicella zoster are sometimes described as "dew drops on a rose petal" (8). The vesicles then dry up and become crusts, which persist for three weeks before disappearing. Children are contagious from two days before to five days after the onset of the rash. A Tzanck smear may be helpful in confirming the diagnosis (reveals multinucleated giant cells) (6), but this is usually unnecessary. Varicella encephalitis may occur shortly after the appearance of the rash, most commonly presenting with mild ataxia. However, the prognosis is usually good, unlike the encephalitis caused by herpes simplex virus. Immunocompromised patients with varicella zoster infections may experience persistent vesicular eruptions that may become hemorrhagic or they may experience disseminated varicella. Acyclovir may be administered in cases of severe varicella, but some advocate routine use of acyclovir for varicella or zoster, especially for adolescents due to their propensity to develop severe disease. Herpes zoster, or shingles, is characterized by groups of vesicles distributed along a cutaneous nerve (a dermatome). As in chickenpox, the vesicles dry up into crusts and disappear within three weeks. They are often compressed against the surface of the foot due to continual weight bearing pressure and may be painful. They are slightly raised, typically less than 3mm in diameter, and appear in crops of 10-30 or more. Their color ranges from pink to brown, and may occur on the forehead and dorsum of the hand. In a young child, these warts may have been transmitted through the birth canal, through spread from cutaneous warts, or they may signify child abuse. Condyloma acuminata are moist, soft, papillomatous lesions that may occur as single or multiple lesions. When treating warts, it is imperative to protect the surrounding skin from irritation. Prior to treatment, plantar, palmar, and common warts should be pared down until the capillaries are revealed. Liquid nitrogen or cantharidin may be used to treat common warts as well as light electrodesiccation and curettage. Common warts and plantar warts may respond to lactic acid or salicylic acid treatments (over the counter topical wart medication). The lesions are small, firm, skin colored papules that are centrally umbilicated. They may appear as one or multiple lesions, and tend to be approximately 1-5 mm in diameter. The papules may occur anywhere on the body, but are usually found on the trunk, face, arms, and genital region. This infection typically spontaneously resolves within six to nine months, however, treatment may prevent autoinoculation and person to person spread (1). Treatment includes curettement, electrosurgery, cryosurgery, or other standard wart medications. There are three types of lice: body or clothing lice (Pediculus humanus corporis), head lice (Pediculus humanus capitis), and pubic or crab lice (Phthirus pubis). The female louse lays eggs, which may be seen attached to hair follicles or clothing fibers. The diagnosis is made by identifying lice or eggs (nits) on the hair shaft or clothing fibers. It may be seen in conditions of poor hygiene, especially in colder environments when the opportunity to change clothes regularly is lacking. The primary lesion found on the shoulders, trunk or buttocks, is a small, red macule or papule with a central hemorrhagic punctum. Treatment consists of improved hygiene and washing all infested clothing and bedding in hot water. Alternatively, the lice will starve if clothing is stored at 75-85 degrees F for two weeks. For those unable to change clothes, clothes may be dusted with 10% lindane powder. Lindane lotion or permethrin cream may be applied for 8-12 hours to eradicate eggs and lice on body hair. Transmission occurs by head-to-head contact, and shared combs, brushes, or towels. The hair is then washed, and the dead nits are then removed from the hair shafts by a fine toothed comb. Other shampoo treatments include permethrin 1% creme rinse (Nix or Elimite), pyrethrin shampoo, or 1% lindane shampoo (Kwell).

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Using these sources 300 mg eskalith, we developed a narrative description of the valve classes generic eskalith 300mg on line, goals in valve design order cheap eskalith, and the theoretical advantages and disadvantages of different types of valves. For Question 2, we scanned the existing literature comparing different types of conventional. We sought to describe the available comparative studies in terms of the number of available studies, interventions compared, basic study design, size of study, length of followup, and outcomes assessed. We identified potentially important observational studies primarily by reviewing the individual studies included in the systematic reviews that met our full-text inclusion criteria. A single reviewer screened the titles and abstracts of all citations for potential inclusion. Articles were included if they concerned conventional heart valves and appeared to be a review article. Citations included at the title-and-abstract stage were reviewed in full-text form independently by two researchers. Articles meeting the following criteria were included for data abstraction: the article was a systematic review, defined as a review including both a Methods section describing a search strategy and analytic approach, and abstractions of primary literature; and the review directly compared two or more different types of conventional heart valves; and the review concerned valve replacement (rather than repair); and the review focused on adults (all patients 18 years of age or, if mixed population, then either 80 percent adults or results reported separately for adults); and the review was published in English in the year 2000 or later. When the two reviewers arrived at different conclusions about whether to include or exclude an article, they were asked to reconcile the difference. The inclusion criteria applied at both screening stages were: Comparison of two or more heart valves for valve replacement (rather than repair); and Randomized allocation to treatment; and Study conducted in adults (all patients 18 years of age or, if mixed population, then either 80 percent adults or results reported separately for adults); and Study published in English. If there was any uncertainty about whether an article should be included, a second investigator was consulted. A second investigator was consulted in cases where there was uncertainty about whether an article should be included. For Question 2, we completed detailed evidence tables only for the included systematic reviews (Appendix B, Evidence Table 1). Data abstracted included the number and designs of included studies, patient descriptors, heart valves compared, and outcomes reported. The methodological quality of the included systematic reviews was evaluated independently by two investigators using a quality assessment tool developed specifically for this project. The 10 quality criteria assessed were stated in question form; possible responses were “Yes,” “Partially,” “No,” or “Can’t tell. When the two investigators disagreed in their assessments, they met to reconcile the difference. The results of quality assessments for individual systematic reviews are reported in Evidence Table 1 (Appendix B). We scanned the existing published and gray literature on different types of percutaneous heart valves to synthesize information on the variables specified in Question 3. We also conducted an extensive search of the gray literature for this question (last search date December 31, 2008). We were assisted in this effort by a librarian with expertise in gray literature searching, who suggested sources and search terms. The gray literature sources consulted, search terms used, and results are described in Table 1. All citations that appeared to report primary data on studies of percutaneous heart valves in humans were included at this stage, with no limit by language or heart valve position. Articles meeting the following criteria were included for data abstraction: Interventions included percutaneous heart valves; and Study involved valve replacement (rather than repair); and Primary data were reported; and Study was conducted in humans; and Study was conducted in adults (all patients 18 years of age or, if mixed population, then either 80 percent adults or results reported separately for adults); and At least 1 clinical outcome was reported. Note that no restrictions were imposed regarding: Study design (all designs acceptable); or Sample size (n 1 acceptable). A single investigator searched the general gray literature sources listed in Table 1 and screened the material identified for potential relevance using the inclusion/exclusion criteria described above for published studies. A single investigator also searched the sources listed in Table 1 for potentially relevant abstracts from recent scientific meetings. Titles and abstracts were screened online, and potentially relevant abstracts were then reviewed in full using the inclusion/exclusion criteria described above for published studies. Abstracts meeting the inclusion criteria were further screened to eliminate those abstracts that duplicated information reported more fully in published studies. For Question 3, we created detailed evidence tables only for published studies (Appendix B, Evidence Table 2). Data abstracted included: date of publication; country; study design; study objectives; duration of followup; number, age, and sex of participants; indication for percutaneous heart valve; valve name; size of catheter; implementation approach; implantation rates; and clinical outcomes, including hemodynamic measurements and 30-day mortality rates, complications, and device dysfunction rates. Important data from the included gray literature and Scientific Information Packets were abstracted into summary tables included in the Results section. Purely descriptive statistics are used to summarize and analyze the data abstracted from the fully published reports, as is appropriate for a horizon scan of literature comprised solely of non-comparative studies. The studies included for this question were not formally assessed for methodological quality. Question 4 focused on variables associated with surgery or setting that may impact outcomes for percutaneous heart valves. In consultation with experts in cardiology and cardiac surgery, we elected to broaden our focus beyond the specific variables listed in the question to include other variables that usually impact outcomes for surgical procedures and that we expected would be reported in published reports identified by our search strategy. In the end, we considered six general categories of variables: (1) prosthesis characteristics; (2) implantation approach; (3) treatment setting; (4) operator characteristics; (5) type of anesthesia; and (6) patient characteristics. For the purpose of answering this question, we focused on device implantation success rates and 30-day survival rates as outcome measures. These two outcomes were consistently reported in most of the studies, and they serve as reasonable proxy measures for the feasibility of delivering prosthetic heart valves percutaneously, as well as for short-term clinical outcomes. For Question 4, we considered a subset of the literature identified for Question 3, namely, the 62 fully published reports that met the inclusion criteria for that question. The methods used to search the published literature, screen potentially relevant citations, and abstract and evaluate data are described above, under Question 3.


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