School climate, attitude toward school violence, and violent behaviors among high school students in Vietnam.

This study aimed to examine the relationship between Vietnamese high school students' violent behaviors and their violence exposure (observing and being victimized by school violence), and attitude, and perceived school climate. The results from 496 Vietnamese high school students show that students' acceptance of school violence and their experience of being the victim of school violence have a significant, and direct, positive effect on their violent behaviors at school. In the moderation model, when students' perception of school climate is more positive, the effect of their acceptance of violence on their violent behaviors at school reduces, implying the moderating effect of school climate. The results have practical implications for educators and policy makers to intervene school violence in Vietnam.

Completed Surgical Repair of Common Arterial Trunk Type I at 16 Years old Without Pulmonary Protection.

We report a successful surgical repair of type I common arterial trunk in a 16-year-old male patient without pulmonary stenosis, nor any previous palliative interventions.

Continuous cerebral perfusion for aortic arch repair: hypothermia versus normothermia.

BACKGROUND: Deep hypothermia with circulatory arrest (CA) is routinely used for aortic arch repair. Antegrade selective cerebral perfusion (ASCP) has been proposed to avoid neurologic complications. The optimal temperature during aortic arch repair with ASCP is not well established. We therefore compared early outcomes of patients undergoing aortic arch repair associated with intracardiac repair with ASCP either with hypothermia (<28°C, group I; n=70) or normothermia (>34°C, group II; n=40). METHODS: From 2002 to 2008, 110 consecutive patients with interrupted aortic arch (n=40) or coarctation of the aorta (n=70) and cardiac anomalies underwent intracardiac and aortic arch repair without CA. Median age at repair was 12 days. Full cardiopulmonary bypass (CPB), high hematocrit, and high rates of flow were used. ASCP flow was adjusted to maintain arterial pressure at greater than or equal to 50 mm Hg. ASCP was achieved either through a Gore-Tex (W. L. Gore & Associates, Inc., Elkton, MD) graft to the innominate artery (n=36) or by direct cannulation (n=74). An electroencephalogram (EEG) was continuously monitored and 30 patients were monitored by near-infrared spectroscopy (NIRS). RESULTS: Preoperative data were similar in both groups. Group II demonstrated higher ASCP flows (p<0.001). Time to extubation, stay in the intensive care unit (ICU), and postoperative urine output and lactate levels were similar between groups. Mortality was 8.5% in group I versus 10% in group II. During the postoperative course, there were no clinical or electrical neurologic events in either group. CONCLUSIONS: Antegrade selective cerebral perfusion can safely avoid CA. No worse, early, or long-term effects of ASCP with normothermia were found.

Surgical palliation of primary pulmonary arterial hypertension by a unidirectional valved Potts anastomosis in an animal model.

OBJECTIVE: Patients with idiopathic pulmonary hypertension are at risk for right-sided heart failure and sudden death. Despite improvement in pharmacologic management, some still require lung transplantation. Potts anastomosis has been demonstrated as a good palliation in children to alleviate symptoms and medical therapy despite desaturation in the lower part of the body. Young adult patients with pulmonary hypertension and isosystemic pressure remain at risk, particularly at exercise. The goal of this research was to find a palliation for patients in whom suprasystemic pulmonary hypertension developed at exercise. Creating a Potts anastomosis involved a unidirectional valve between the left pulmonary artery and the descending aorta. METHODS: Experimental study was performed on 14 pigs. A prosthetic patch of polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Newark, Del) was used to create the unidirectional valve and implanted in the Potts anastomosis. Via a left thoracotomy, an aorto-aortic shunt between the aortic isthmus and the distal descending thoracic aorta was instituted, allowing a safe surgical procedure. Intrapulmonary injection of Erciplex glue (Peters Surgical, Bobigny, France), diluted in 70% alcohol, was used to create acute pulmonary hypertension. The right to left shunt across the unidirectional valvular patch was evaluated after clamping the aorta in the acute phase of pulmonary hypertension by echo-pulsed Doppler at the level of the descending thoracic aorta by withdrawal of blood gas (arterial carbon dioxide tension, alveolar carbon dioxide tension) and assessment of peripheral oxygen saturation. Similar reevaluation of the shunt was performed at a mean interval of 13 ± 2.5 weeks. RESULTS: In the first series, Erciplex glue increased pulmonary artery pressure from 15.3 ± 3.1 mm Hg to 38.7 ± 6.0 mm Hg. Mean peripheral oxygen saturation decreased from 100% to 85% ± 1.5%. Mean partial pressure of carbon dioxide increased from 31.9 ± 9.1 mm Hg to 46.2 ± 12.5 mm Hg after shunt opening (P < .01), and mean peripheral oxygen decreased from 435.1 ± 109.4 mm Hg to 261.9 ± 77.9 mm Hg (P < 0.05), indicating right to left shunt through the Potts valve (P < .013). Pulsed Doppler showed a mean peak laminar flow of 133.3 ± 35.3 cm/s before aortic clamping, turbulent flow of 234.9 ± 40.1 cm/s after glue injection, and return of laminar flow 128.5 ± 30.1 cm/s after aortic isthmus unclamping. In the second series, the same results were obtained but with a lesser peak flow velocity because of the endothelialization on the valvular patch. Gross analysis of the patch did not show thrombosis, aneurysm, or fissure. CONCLUSIONS: Palliation of exercise suprasystemic pulmonary hypertension was demonstrated by a unidirectional valved Potts anastomosis. This technique can be of help in young adult patients with pulmonary hypertension and isosystemic pressure but with exercise intolerance.