Aortic Atresia or Complex Left Outflow Tract Obstruction in the Presence of a Ventricular Septal Defect.

Severe left outflow tract obstruction (LVOTO) is not always associated with hypoplastic left heart syndrome (HLHS). Aortic valvar atresia or complex LVOTO in the presence of a large ventricular septal defect (VSD) are a rare group of lesions that offer the possibility of biventricular repair. The Yasui procedure is the commonest surgical approach which can be performed as a primary neonatal correction or as a staged procedure with a Norwood followed by a subsequent Rastelli. This article reviews the surgical outcomes and decision-making process. Both strategies are reasonable with the trend toward staged procedure in the setting of the additional interrupted arch, with neonatal survival of > 90% in the modern era and excellent long-term survival. Re-intervention is mostly related to conduit revision and the need for re-operation for LVOTO is rare. Deciding between conventional repair and the Yasui in cases of LVOTO/VSD can be difficult and there are no uniform accepted criteria. In a typical neonate, an aortic annulus < 4.5 mm is generally the limit of acceptability for a conventional repair. In selected cases of LVOTO/VSD, an alternative to the Yasui is the Ross-Konno. Retrospective comparisons between the 2 techniques are difficult due to differing patient characteristics (especially associated with mitral valve disease) but the neonatal Ross has been associated with higher early mortality.

The Gut Virome Database Reveals Age-Dependent Patterns of Virome Diversity in the Human Gut.

The gut microbiome profoundly affects human health and disease, and their infecting viruses are likely as important, but often missed because of reference database limitations. Here, we (1) built a human Gut Virome Database (GVD) from 2,697 viral particle or microbial metagenomes from 1,986 individuals representing 16 countries, (2) assess its effectiveness, and (3) report a meta-analysis that reveals age-dependent patterns across healthy Westerners. The GVD contains 33,242 unique viral populations (approximately species-level taxa) and improves average viral detection rates over viral RefSeq and IMG/VR nearly 182-fold and 2.6-fold, respectively. GVD meta-analyses show highly personalized viromes, reveal that inter-study variability from technical artifacts is larger than any "disease" effect at the population level, and document how viral diversity changes from human infancy into senescence. Together, this compact foundational resource, these standardization guidelines, and these meta-analysis findings provide a systematic toolkit to help maximize our understanding of viral roles in health and disease.

The influence of weight-of-evidence strategies on audience perceptions of (un)certainty when media cover contested science.

Controversy in science news accounts attracts audiences and draws attention to important science issues. But sometimes covering multiple sides of a science issue does the audience a disservice. Counterbalancing a truth claim backed by strong scientific support with a poorly backed argument can unnecessarily heighten audience perceptions of uncertainty. At the same time, journalistic norms often constrain reporters to "get both sides of the story" even when there is little debate in the scientific community about which truth claim is most valid. In this study, we look at whether highlighting the way in which experts are arrayed across truth claims-a strategy we label "weight-of-evidence reporting"-can attenuate heightened perceptions of uncertainty that can result from coverage of conflicting claims. The results of our study suggest weight-of-evidence strategies can indeed play a role in reducing some of the uncertainty audiences may perceive when encountering lop-sided truth claims.

Use of predictive energy expenditure equations in individuals with lower limb loss at seated rest.

BACKGROUND: As a result of the global war on terrorism, there has been a significant increase in young service members with traumatic amputations. Few published data are available on metabolic requirements for young, active individuals after traumatic limb loss, especially lower limb loss. OBJECTIVE: The purpose of this study was to determine which predictive energy equation best predicted resting energy expenditure (REE) in this population. METHODS: One hundred service members, 50 with at least one traumatic lower limb loss and 50 without limb loss, completed this study. Mean (standard deviation [SD]) age, height, and weight were 27.3 years (±5.3), 178.5 cm (±7.7), 86.5 kg (±15.8) for those with limb loss; and 29.4 years (±5.8), 179.1 cm (±6.7), 85.9 kg (±12.6) for those without. REE was measured using the Oxycon Mobile metabolic system (CareFusion). Measured REE was compared with the following REE equations: Mifflin-St Joer, Harris Benedict, Owen, 25 kcal/kg, and 30 kcal/kg. RESULTS: All equations tended to underestimate or overestimate REE for both groups (P<0.001); however, the 25 kcal/kg had a more even distribution of disagreement for individuals with limb loss and without (P=0.100 and P=0.308, respectively), with 52% within ±10%. CONCLUSIONS: The 25 kcal/kg best predicts REE for young, active individuals with or without limb loss. Future studies may determine that more appropriate equations are most useful for different subgroups of this population.