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• Patient is at least 35 years of age.
• Patient has chronic bronchitis, defined as productive cough for three months in each
of two successive years, whereas other causes of productive cough have been ruled out.
• Patient has a CAT score ≥ 10.
• Patient has an SGRQ score ≥ 25.
• Patient's responses to the first two questions of the CAT instrument sum to ≥ 7 points
or the sum is 6 points and the patient's total CAT score is > 20 points.
• Patient has FEV1/FVC < 0.70.
• Patient has a pre-procedure post-bronchodilator FEV1 percent predicted of ≥ 30%.
• Patient is receiving guideline directed pharmacotherapy which includes one or more
long acting bronchodilator (LAMA, LABA) with or without an inhaled corticosteroid for
at least 8 weeks prior to randomization, unless the patient has attempted such therapy
within the past 1 year without significant clinical response or had an adverse
reaction.
• Patient has a cigarette smoking history of at least ten pack years.
• In the opinion of the Primary investigator, patient is able to undergo 2
bronchoscopies under general anesthesia and is able to adhere to the study follow-up
schedule
Exclusion Criteria:
• Patient has known unresolved lower respiratory tract infection (e.g., pneumonia,
mycobacterium avium-intracellulare infection (MAI), fungus, tuberculosis).
• Patient has a steroid-dependent condition requiring >10 mg of oral corticosteroid per
day.
• Patient has any implantable electronic device (e.g., pacemaker, cardioverter
defibrillator) that cannot be turned off during the procedure.
• Patient has a history of ventricular tachy-arrhythmia or clinically significant atrial
tachyarrhythmia within the past two years, unless the arrhythmia has been treated
and/or patient is in regular rhythm during the screening phase.
• Patient has unresolved lung cancer.
• Patient has a pulmonary nodule or cavity that in the judgement of the Primary
investigator may require intervention during the course of the study.
• Patient had prior lung surgery, such as lung transplant, LVRS, lobectomy, lung
implant/prosthesis, metal airway stent, valves, coils or bullectomy. Prior
pneumothorax without lung resection, pleural procedures without surgery, or
segmentectomy are acceptable.
• Patient has emphysema of greater than or equal to 25% as quantified on baseline HRCT
scan (low attenuation area less than -950HU) as determined by the CT Core Lab.
• Patient has asthma based on Global Initiative for Asthma (GINA) criteria.
• Patient has clinically significant bronchiectasis influencing the patient's clinical
symptoms of cough and phlegm.
• Patient has actively smoked (including tobacco, marijuana, e-cigarettes, vaping, etc.)
within the last 6 months.
• Patient is unable to walk over 225 meters in 6 minutes.
• Patient has a serious medical condition that, in the Primary investigator's opinion,
could compromise patient safety or confound the interpretation of the patient's
response to therapy (e.g., congestive heart failure, cardiomyopathy, or myocardial
infarction in the past year, renal failure, liver disease cerebrovascular accident
within the past 6 months, uncontrolled diabetes (HbA1c >8%), uncontrolled hypertension
(diastolic BP >100mmHg) or autoimmune disease requiring treatment with
immunosuppressant medications or a disease requiring chemotherapy).
• Patient has uncontrolled GERD.
• Patient has known severe pulmonary hypertension.
• Patient has a known sensitivity to medication required to perform bronchoscopy (i.e.,
lidocaine, atropine, benzodiazepines).
• Patient is pregnant, nursing, or planning to get pregnant during study duration.
• Patient is currently participating in another clinical study involving an
investigational product
Anus, Any Site, Bones and Joints, Breast, Brain and Nervous System, Other Hematopoietic, Other Female Genital, Other Endocrine System, Other Digestive Organ, Non-Hodgkin's Lymphoma, Myeloid and Monocytic Leukemia, Mycosis Fungoides, Multiple Myeloma, Melanoma, skin, Lymphoid Leukemia, Lung, Liver, Lip, Oral Cavity and Pharynx, Leukemia, other, Leukemia, Not Otherwise Specified, Larynx, Kidney, Kaposi's sarcoma, Ill-Defined Sites, Hodgkin's Lymphoma, Eye and Orbit, Esophagus, Corpus Uteri, Colon, Cervix, Other Male Genital, Other Respiratory and Intrathoracic Organs, Other Urinary, Urinary Bladder, Thyroid, Stomach, Soft Tissue, Small Intestine, Rectum, Prostate, Pancreas, Ovary, Other Skin
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Virginia Commonwealth University Richmond, Virginia
• Injury meeting at least one of the following criteria:
* Gustilo type III tibia (OTA 41 plateau, OTA 42 shaft and OTA 43 pilon) requiring a second procedure for final debridement and definitive coverage / closure following the index stabilization
* Gustilo type IIIB ankle fractures (OTA 44)
* Gustilo type IIIB calcaneus fractures (OTA 82)
* Gustilo type IIIB talus fractures (OTA 81)
* Traumatic "zone-of-injury" trans-tibial amputations requiring DPC, and/or flap coverage
• Ages 18 - 64 years inclusive
• Patients may have risk factors for infection including diabetes, immunosuppression from steroids or other medications, HIV, or other infections.
• Patients may have a traumatic brain injury.
• Patients may have other fractures including spine, upper extremity fractures, contralateral lower extremity injuries, ipsilateral pelvis, hip, femur or foot injuries.
• Patients may be treated initially at an outside institution prior to transfer to the study institution, as long as the definitive wound closure or coverage was not performed prior to entrance into the study.
• Patients with bilateral injuries that meet inclusion criteria may be included, but only the limb rated as "more severe" by the treating surgeon will be enrolled in the study.
• Patients may have co-existing non-tibial or hindfoot infection, with or without antibiotic treatment.
• Patients may be definitively stabilized using any method (nail, plate, ex fix or cast).
• Patients may have a fasciotomy.
Exclusion Criteria:
• Patient in current therapy for a wound, implant or fracture site infection related to the study site.
• Patient likely to have difficulty maintaining follow-up, including:
* Diagnosis of a severe psychiatric condition
* Intellectually challenged without adequate family support
* Resides outside of the hospital's catchment area
* Planning to follow-up at another medical center
* Being a prisoner
* Not having a means of contact (address, cell phone, home phone, e-mail)
DRUG: Standard of care, DRUG: Vancomycin and Tobramycin
Post Operative Surgical Site Infection
Surgical site infection risk prevention, Bacterial species type and antibacterial sensitivities
Melanoma, skin, Other Urinary, Urinary Bladder, Thyroid, Stomach, Soft Tissue, Small Intestine, Rectum, Prostate, Pancreas, Ovary, Other Respiratory and Intrathoracic Organs, Other Male Genital, Other Female Genital, Other Endocrine System, Other Digestive Organ, Lung, Liver, Lip, Oral Cavity and Pharynx, Larynx, Kidney, Eye and Orbit, Ill-Defined Sites, Esophagus, Corpus Uteri, Colon, Cervix, Breast, Brain and Nervous System, Bones and Joints
• Adults ≥18 years
• At least one episode of diverticulitis confirmed by CT scan (or pending confirmation) and a colonoscopy (completed or scheduled) to rule out or screen for other colon pathology concordant with screening guidelines; AND A. History of recurrent uncomplicated diverticulitis without current symptoms (AUD in remission); OR B. Persistent signs, symptoms, and concerns related to diverticular disease ≥3 months after recovery from an episode of AUD (e.g., excluding irritable bowel syndrome and other conditions in coordination with gastroenterologist)
Exclusion Criteria:
• Unable or unwilling to return or be contacted for and/or complete research surveys;
• Currently incarcerated in a detention facility or in police custody (patients wearing a monitoring device can be enrolled) at baseline/screening;
• Previous operation for diverticulitis
• Current diagnosis or previous endoscopic or surgical interventions for fistula or stricture or current significant bleeding related to diverticular disease.
• Right-sided diverticulitis
• Comorbid or prior surgical conditions that contraindicate elective surgery (e.g., liver failure, renal failure, malignancy, "frozen abdomen")
• Actively undergoing chemotherapy or radiation for malignancy
• Immunodeficiency (e.g., absolute neutrophil count \<500/mm3, chronic immunosuppressive drugs (e.g., oral corticosteroids, anti-TNF agents), or known AIDS \[i.e., recent CD4 count \<200 \] assessed by patient history);
• Taking prescription medication to treat active inflammatory bowel disease (e.g., Crohn's, ulcerative colitis);
• Taking prescription medication for irritable bowel syndrome;
• Pregnant or expectation of becoming pregnant in the 30 days following baseline/screening;
• Prior enrollment in the study or other investigational drug or vaccine while on study treatment;
• Abdominal/pelvic surgery in the past month
PROCEDURE: Partial Colectomy, OTHER: Medical Management