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This clinical case demonstrated surgical management for a rare case of vascular ring associated with an elongated and kinked aortic arch and a right descending aorta in a ten-year-old male using an extra-anatomic bypass grafting method and dividing the vascular ring. Computer tomography performed at six-month follow-up showed a favorable surgical outcome.OBJECTIVE Technical performance score (TPS) has been associated with both early and late outcomes across a wide range of congenital cardiac procedures. A previous study has shown that the presence of residual lesions before discharge, as measured by TPS, is accurately able to identify patients who required postdischarge reinterventions after complete atrioventricular septal defect (CAVSD) repair. The aim of this study is to determine which subcomponents of TPS best predict postdischarge reinterventions after CAVSD repair. METHODS This was a single-center retrospective review of patients with CAVSD after repair between January 2000 and March 2016. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention before discharge for residua) based on subcomponent scores from discharge echocardiograms. Outcome of interest was postdischarge reintervention. RESULTS Among 344 patients, median age was 3.2 months (interquartile range [IQR], 2.4-4.2). There were 34 (10%) postdischarge reinterventions. Median follow-up was 2.6 years (IQR, 0.09-7.9). Trisomy 21 and concomitant procedure were associated with postdischarge reinterventions. After adjusting for these factors, among the subcomponents, left atrioventricular valve stenosis and regurgitation, right atrioventricular valve regurgitation, residual ventricular septal defect, and abnormal conduction at discharge were significantly associated with postdischarge reinterventions. CONCLUSIONS We demonstrated the ability of TPS to predict postdischarge reinterventions in patients who underwent CAVSD repair. Residual left and right atrioventricular valve regurgitation and abnormal conduction at discharge were among the subcomponents strongly associated with postdischarge reinterventions. Thus, TPS may aid clinicians in identifying children at higher risk for reintervention.Late systemic outflow tract obstruction following completion of the Fontan palliation is rarely seen and is a difficult problem to treat. Absence of the main pulmonary trunk and pulmonary valve at this stage makes a conventional Damus-Kaye-Stansel connection difficult to achieve. We report the case of a 37-year-old female who underwent Fontan completion as an adult and subsequently presented with systemic outflow tract obstruction. A valved conduit was interposed between the native pulmonary annulus and the ascending aorta to create a modified Damus-Kaye-Stansel type connection.BACKGROUND Despite significant improvement in outcomes with truncus arteriosus (TA) repair, right ventricular outflow tract (RVOT) reconstruction with a right ventricular to pulmonary artery (RV-to-PA) conduit remains a source of long-term reintervention and reoperation. This study evaluated our experience with reintervention in homograft and polytetrafluoroethylene (PTFE) RV-to-PA conduits in neonates. METHODS Primary TA repairs from 2004 to 2016 at a single institution were included. Stratification was based on RVOT reconstruction with PTFE or homograft conduit. Primary outcome was operative conduit replacement. 17β-estradiol in vitro Secondary outcomes included the rates and types of catheter-based conduit interventions. RESULTS Twenty-eight patients underwent primary TA repair and 89.3% (n = 25) of them had RVOT reconstruction with a homograft (28.0%, n = 7) or PTFE (72.0%, n = 18) conduit. Rates of reoperation for conduit replacement and catheter-based interventions were similar between those with PTFE and homograft conduits (85.7% vs 72.2%, P = .49 and 57.1% vs 83.3%, P = .11, respectively). Additionally, the median time to conduit replacement and catheter-based conduit interventions were comparable. In multivariable analysis, conduit size, but not conduit type, was a predictor of conduit revision (hazard ratio 1.66, 95% confidence interval 1.11-2.49, P = .02). At five-year and ten-year follow-up, patients with PTFE conduits had better survival than those with homograft conduits (100.0% vs 71.4%, P = .02); however, no mortalities were associated with conduit reoperations or catheter-based reinterventions. CONCLUSIONS Polytetrafluoroethylene and homograft RVOT reconstruction in neonatal TA repair demonstrate similar durability as defined by reoperation and reintervention rates. The validation of the durability of PTFE conduits in neonatal TA repair requires confirmatory studies in larger cohorts.Cavopulmonary anastomosis was first described by Carlon, Mondini, De Marchi in a canine model in 1951 and later, in the clinical practice, by Glenn in 1958. Total right heart bypass was first introduced by Fontan and Kreutzer in 1971, in each instance as treatment for tricuspid atresia. Several modifications of such a procedure followed the initial concept of the right atrium as a pumping chamber, including modifications aimed to minimize energy loss at the anastomotic level and arrhythmias. Tribute is given to our pioneers who developed such an operation aimed to treat any child with functionally univentricular hearts.Severe local acidosis causes tissue damage and pain, and is associated with many diseases, including cerebral and cardiac ischemia, cancer, infection, and inflammation. However, the molecular mechanisms of the cellular response to extracellular acidic environment are not fully understood. We recently identified a novel and evolutionarily conserved membrane protein, PAC (also known as PACC1 or TMEM206), encoding the proton-activated chloride (Cl-) channel, whose activity is widely observed in human cell lines. We demonstrated that genetic deletion of Pac abolished the proton-activated Cl- currents in mouse neurons and also attenuated the acid-induced neuronal cell death and brain damage after ischemic stroke. Here, we show that the proton-activated Cl- currents are also conserved in primary rat cortical neurons, with characteristics similar to those observed in human and mouse cells. Pac gene knockdown nearly abolished the proton-activated Cl- currents in rat neurons and reduced the neuronal cell death triggered by acid treatment. These data further support the notion that activation of the PAC channel and subsequent Cl- entry into neurons during acidosis play a pathogenic role in acidotoxicity and brain injury.OBJECTIVE The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy. STUDY DESIGN Retrospective observational study of national health care claims. link2 SETTING 2003 to 2016 Optum Clinformatics Data Mart. SUBJECTS AND METHODS In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery. link3 RESULTS The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; t test, P less then .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; t test, P less then .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; t test, P less then .0001). A higher number of children was correlated with lower age for both females (Pearson, r = -0.3817, P less then .0001) and males (Pearson, r = -0. 3675, P less then .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children (F(3, 6021) = 336.93, P less then .001, R2 = 0.1437) with no significant interaction between sex and number of children (P = .186). CONCLUSION Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis.In this work, we presented the synthesis and investigation of binding properties of the new morpholine containing 3-amido-9-ethylcarbazole derivative (CMR) to calf thymus DNA (ctDNA) and human serum albumin (HSA) by fluorescence spectroscopy, UV absorption spectroscopy and molecular docking method. A decrease in Stern-Volmer constants was obtained with increase in temperature; it shows that static quenching mechanism leads to formation of new CMR-DNA/HSA complexes, which have hydrophobic interaction as the predominant role in the binding modes. Also, binding properties of DNA were investigated with competition assays on two probes (EB and H33258) by absorption, ionic strength and iodide ion quenching methods. The results suggested that CMR entered into the minor groove binding on the A-T region of DNA. The spectral data further confirmed by molecular docking which elicited that CMR complexes have similar interaction and conformation trends to each target, DNA and HSA. The experimental and computational results show that CMR has been classified as a promising molecule in drug designing of other carbazole derivatives.Communicated by Ramaswamy H. Sarma.Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults' gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.Background To date, little attention has been paid to the processes by which resilience is developed, and how the likelihood of a resilient outcome may be enhanced over the life course. Objective This study investigates the potential for adaptive systematic self-reflection to support the development of situation resilience via stressor exposure. Design An experimental randomized controlled design was conducted. Participants were randomly assigned to either the Systematic Self-reflection intervention (n = 61) or disengagement control group (n = 60). Method Participants were 121 university students (female = 68%) ranging in age from 18 to 56 years. Participants experienced two psychosocial stressors and completed a baseline survey, a second survey occurred post-stressor 1, and a third post-stressor 2. Salivary cortisol was taken pre stressor 2, immediately post stressor 2, and at 10 min intervals until 30 min. Results The intervention was associated with greater reductions in negative affect, than a disengagement control task, and prevented the continued reduction in positive affect observed in the disengagement control condition.
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