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Seasonally abundant arthropods are a crucial food source for many migratory birds that breed in the Arctic. In cold environments, the growth and emergence of arthropods are particularly tied to temperature. Thus, the phenology of arthropods is anticipated to undergo a rapid change in response to a warming climate, potentially leading to a trophic mismatch between migratory insectivorous birds and their prey. Using data from 19 sites spanning a wide temperature gradient from the Subarctic to the High Arctic, we investigated the effects of temperature on the phenology and biomass of arthropods available to shorebirds during their short breeding season at high latitudes. We hypothesized that prolonged exposure to warmer summer temperatures would generate earlier peaks in arthropod biomass, as well as higher peak and seasonal biomass. Across the temperature gradient encompassed by our study sites (>10°C in average summer temperatures), we found a 3-day shift in average peak date for every increment of 80 cumulative thawing degree-days. Interestingly, we found a linear relationship between temperature and arthropod biomass only below temperature thresholds. Higher temperatures were associated with higher peak and seasonal biomass below 106 and 177 cumulative thawing degree-days, respectively, between June 5 and July 15. Beyond these thresholds, no relationship was observed between temperature and arthropod biomass. Our results suggest that prolonged exposure to elevated temperatures can positively influence prey availability for some arctic birds. This positive effect could, in part, stem from changes in arthropod assemblages and may reduce the risk of trophic mismatch.
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Artrópodos , Biomasa , Estaciones del Año , Temperatura , Animales , Regiones Árticas , Artrópodos/fisiología , Cambio Climático , Cadena Alimentaria , Charadriiformes/fisiología , Migración AnimalRESUMEN
Pain is common in paediatric populations and is best treated with a multi-disciplinary approach. Art therapy interventions are gaining popularity in paediatrics; however, there is limited evidence on its impact on pain outcomes in children and adolescents. The objective of this scoping review is to map current research on art therapy's impact as an intervention in paediatric populations experiencing any type of pain (i.e., acute, recurrent, and chronic). Electronic searches were conducted by a medical librarian to identify studies that used art therapy interventions in paediatric populations with pain as an outcome measure. Four reviewers independently screened and selected articles for extraction using Covidence and data were extracted from articles using study objectives. There were five studies that met the inclusion criteria. Four of the five studies reported on pain intensity and all studies reported on emotional functioning. Findings suggest art therapy interventions can be helpful for reducing pain, anxiety, stress, and fear associated with treatment. Further, there is emerging evidence that art therapy can support the management of acute and procedural pain in children. Future research should examine the impacts of integrating art therapy interventions into the multidisciplinary management of paediatric pain.
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Global climate change has altered the timing of seasonal events (i.e., phenology) for a diverse range of biota. Within and among species, however, the degree to which alterations in phenology match climate variability differ substantially. To better understand factors driving these differences, we evaluated variation in timing of nesting of eight Arctic-breeding shorebird species at 18 sites over a 23-year period. We used the Normalized Difference Vegetation Index as a proxy to determine the start of spring (SOS) growing season and quantified relationships between SOS and nest initiation dates as a measure of phenological responsiveness. Among species, we tested four life history traits (migration distance, seasonal timing of breeding, female body mass, expected female reproductive effort) as species-level predictors of responsiveness. For one species (Semipalmated Sandpiper), we also evaluated whether responsiveness varied across sites. Although no species in our study completely tracked annual variation in SOS, phenological responses were strongest for Western Sandpipers, Pectoral Sandpipers, and Red Phalaropes. Migration distance was the strongest additional predictor of responsiveness, with longer-distance migrant species generally tracking variation in SOS more closely than species that migrate shorter distances. Semipalmated Sandpipers are a widely distributed species, but adjustments in timing of nesting relative to variability in SOS did not vary across sites, suggesting that different breeding populations of this species were equally responsive to climate cues despite differing migration strategies. Our results unexpectedly show that long-distance migrants are more sensitive to local environmental conditions, which may help them to adapt to ongoing changes in climate.
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Migración Animal , Cambio Climático , Comportamiento de Nidificación , Estaciones del Año , Animales , Regiones Árticas , Migración Animal/fisiología , Femenino , Charadriiformes/fisiología , ReproducciónRESUMEN
Objectives: Delays in identification, resuscitation and referral have been identified as a preventable cause of avoidable severity of illness and mortality in South African children. To address this problem, a machine learning model to predict a compound outcome of death prior to discharge from hospital and/or admission to the PICU was developed. A key aspect of developing machine learning models is the integration of human knowledge in their development. The objective of this study is to describe how this domain knowledge was elicited, including the use of a documented literature search and Delphi procedure. Design: A prospective mixed methodology development study was conducted that included qualitative aspects in the elicitation of domain knowledge, together with descriptive and analytical quantitative and machine learning methodologies. Setting: A single centre tertiary hospital providing acute paediatric services. Participants: Three paediatric intensivists, six specialist paediatricians and three specialist anaesthesiologists. Interventions: None. Measurements and main results: The literature search identified 154 full-text articles reporting risk factors for mortality in hospitalised children. These factors were most commonly features of specific organ dysfunction. 89 of these publications studied children in lower- and middle-income countries. The Delphi procedure included 12 expert participants and was conducted over 3 rounds. Respondents identified a need to achieve a compromise between model performance, comprehensiveness and veracity and practicality of use. Participants achieved consensus on a range of clinical features associated with severe illness in children. No special investigations were considered for inclusion in the model except point-of-care capillary blood glucose testing. The results were integrated by the researcher and a final list of features was compiled. Conclusion: The elicitation of domain knowledge is important in effective machine learning applications. The documentation of this process enhances rigour in such models and should be reported in publications. A documented literature search, Delphi procedure and the integration of the domain knowledge of the researchers contributed to problem specification and selection of features prior to feature engineering, pre-processing and model development.
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Repression has been linked to greater illness, somatic symptoms, and poorer physical health, both in adult and pediatric populations. The current study examined psychological and pain profiles of children with chronic pain who may under-report levels of psychological distress at a first interdisciplinary chronic pain assessment. Children and their caregiver completed measures of psychopathology and pain intensity, while clinicians rated their levels of disability. Based on self-report measures, children were classified as "repressors" (low anxiety/high social desirability) or as "true low anxious" (low anxiety/low social desirability). Groups were then compared on psychological and pain characteristics. Compared to children with true low anxiety, repressors reported lower levels of depressive and somatic symptoms but provided higher ratings on pain intensity, pain-unpleasantness, and self-oriented perfectionism. Caregivers of repressors rated their children as having higher levels of adaptability compared to caregivers of children in the true low anxious group. Groups did not differ on clinician-rated level of disability. Children classified as repressors exhibited different profiles than children classified as having true low anxiety on both psychological outcomes and pain characteristics. Repression may be an important factor to consider for those assessing and treating children with chronic pain.
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Dolor Crónico , Síntomas sin Explicación Médica , Adulto , Niño , Humanos , Autoinforme , Represión Psicológica , Adaptación Psicológica , Ansiedad/psicologíaRESUMEN
Objectives: Failures in identification, resuscitation and appropriate referral have been identified as significant contributors to avoidable severity of illness and mortality in South African children. In this study, artificial neural network models were developed to predict a composite outcome of death before discharge from hospital or admission to the PICU. These models were compared to logistic regression and XGBoost models developed on the same data in cross-validation. Design: Prospective, analytical cohort study. Setting: A single centre tertiary hospital in South Africa providing acute paediatric services. Patients: Children, under the age of 13 years presenting to the Paediatric Referral Area for acute consultations. Outcomes: Predictive models for a composite outcome of death before discharge from hospital or admission to the PICU. Interventions: None. Measurements and main results: 765 patients were included in the data set with 116 instances (15.2%) of the study outcome. Models were developed on three sets of features. Two derived from sequential floating feature selection (one inclusive, one parsimonious) and one from the Akaike information criterion to yield 9 models. All developed models demonstrated good discrimination on cross-validation with mean ROC AUCs greater than 0.8 and mean PRC AUCs greater than 0.53. ANN1, developed on the inclusive feature-et demonstrated the best discrimination with a ROC AUC of 0.84 and a PRC AUC of 0.64 Model calibration was variable, with most models demonstrating weak calibration. Decision curve analysis demonstrated that all models were superior to baseline strategies, with ANN1 demonstrating the highest net benefit. Conclusions: All models demonstrated satisfactory performance, with the best performing model in cross-validation being an ANN model. Given the good performance of less complex models, however, these models should also be considered, given their advantage in ease of implementation in practice. An internal validation study is now being conducted to further assess performance with a view to external validation.
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OBJECTIVE: To assess thermal-sensory thresholds and psychosocial factors in children with Complex Regional Pain Syndrome Type 1 (CRPS-I) compared to healthy children. METHODS: We conducted quantitative sensory testing on 34 children with CRPS-I and 56 pain-free children. Warm, cool, heat, and cold stimuli were applied to the forearm. Children with CRPS-I had the protocol administered to the pain site and the contralateral-pain site. Participants completed the self-report Behavior Assessment System for Children. RESULTS: Longer pain durations (>5.1 months) were associated with decreased sensitivity to cold pain on the pain site (P = .04). Higher pain-intensity ratings were associated with elevated anxiety scores (P = .03). Anxiety and social stress were associated with warmth sensitivity (both P < .05) on the contralateral-pain site. CONCLUSIONS: Pain duration is an important factor in assessing pediatric CRPS-I. Hyposensitivity in the affected limb may emerge due to degeneration of nociceptive nerves. Anxiety may contribute to thermal-sensory perception in childhood CRPS-I.
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Síndromes de Dolor Regional Complejo/fisiopatología , Síndromes de Dolor Regional Complejo/psicología , Dimensión del Dolor/métodos , Sensación/fisiología , Canadá , Niño , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
Coadministration of human secretory IgA (sIgA) together with subtherapeutic vancomycin enhanced survival in the Clostridioides difficile infection (CDI) hamster model. Vancomycin (5 or 10 mg/kg × 5 days) plus healthy donor plasma sIgA/monomeric IgA (TID × 21 days) or hyperimmune sIgA/monomeric IgA (BID × 13 days) enhanced survival. Survival was improved compared to vancomycin alone, P = .018 and .039 by log-rank Mantel-Cox, for healthy and hyperimmune sIgA, respectively. Passive immunization with sIgA (recombinant human secretory component plus IgA dimer/polymer from pooled human plasma) can be administered orally and prevents death in a partially treated CDI hamster model.
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Antibacterianos/uso terapéutico , Clostridioides difficile , Infecciones por Clostridium/terapia , Inmunoglobulina A Secretora/uso terapéutico , Inmunoterapia/métodos , Vancomicina/uso terapéutico , Animales , Cricetinae , Humanos , Inmunoglobulina A , Factores InmunológicosRESUMEN
Hereditary haemorrhagic telangiectasia (HHT) is supposedly rare in Africa, with only three pathogenic variants documented to date. We describe the clinical and genetic features of HHT patients in central South Africa, who fulfilled the Curaçao criteria. Sixteen patients (median age 38.5 years, range 12-65 years), from six families were included. Fifteen patients were of African descent and one was of Afrikaner descent. The mean epistaxis severity score was 3.18, and the median haemoglobin was 9.5 g/dL (range 3.5-13.5 g/dL). On transthoracic contrast echocardiography 69% had a shunt grade ≥ 1, but only 20% had pulmonary arteriovenous malformations (AVMs) on computed tomography of the chest. Hepatic AVMs were found in 13% of patients, while 13% had brain vascular malformations. Four patients were HIV positive, of whom two had worsening epistaxis while they had opportunistic infections and poor HIV control. We identified six pathogenic variants (four in ENG and two in ACVRL1) in the six probands, three of which had been described previously. Three variants have apparently not been reported previously: ENG c.[1336_1337dup];[ =] p.[(Asp446fs)];[( =)], ENG c.[ 690?_816+?del] p.[(?)], and ACVRL1 c.[268_274delins57];[ =] p.[(Cys90fs)];[( =)]. We confirmed the diagnosis of HHT in sixteen patients and identified pathogenic variants in ENG or ACVRL1 in all six probands in central South Africa, where HHT has been underreported. We describe three pathogenic variants: two of ENG and one of ACVRL1. We will be able to implement pre-symptomatic screening of patients in our area, and improve their management.
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Receptores de Activinas Tipo II/genética , Endoglina/genética , Telangiectasia Hemorrágica Hereditaria/genética , Adolescente , Adulto , Anciano , Niño , Comorbilidad , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mutación , Sudáfrica/epidemiología , Telangiectasia Hemorrágica Hereditaria/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Studies have been conducted describing the potential for using virtual care software during disasters and public health emergencies. However, limited data exist on ways in which the Canadian health care system utilizes virtual care during disasters or public health emergencies. AIMS: Due to the need for social distancing and reduction of nonessential ambulatory services during the COVID-19 pandemic, the SickKids Chronic Pain Clinic sought to transition care delivery from in person to virtual. The virtual clinic aimed to reduce risks associated with physical contact and environmental exposure without reducing access to care itself. METHODS: Harnessing of various digital tools including Ontario Telemedicine Network Guestlink, Zoom, and Microsoft Teams. The Chronic Pain Clinic Team worked together to communicate with patients and families, schedule virtual visits, establish remote access to clinical data collection tools, digitize the after-visit summary, and add resources on pain self-management to the clinic's website. RESULTS: The Chronic Pain Clinic successfully transitioned all clinic appointments (multidisciplinary and individual; 77 appointments) over a 2-week period to virtual care. Virtual clinics did not surpass the usual time taken pre-COVID-19, suggesting that the clinic workflow was readily adaptable to virtual care. CONCLUSIONS: Access to quality virtual care is essential to prevent chronic pain from taking a toll on the lives of patients and families. Rapid establishment of a virtual clinic without gaps in service delivery to patients is possible given institutional support and a team culture centered around collaboration and flexibility.
Contexte: Des études ont été menées pour décrire le potentiel d'utilisation des logiciels de soins virtuels lors de catastrophes et d'urgences de santé publique. Toutefois, il existe peu de données sur les moyens par lesquels le systéme de soins de santé canadien utilise les soins virtuels lors de catastrophes ou d'urgences de santé publique.But: En raison de la nécessité d'une distanciation sociale et de la réduction des services ambulatoires non essentiels pendant la pandémie de COVID-19, la clinique de douleur chronique de SickKids a cherché à assurer une transition de la prestation des soins en personne vers des soins virtuels. La clinique virtuelle visait à réduire les risques liés au contact physique et à l'exposition environnementale sans réduire l'accès aux soins en tant que tels.Méthodes: Exploitation de divers outils numériques, dont le Réseau de télémédecine de l'Ontario Guestlink, Zoom et Microsoft Teams. L'équipe de la Clinique de la douleur chronique a travaillé ensemble pour communiquer avec les patients et les familles, programmer des visites virtuelles, établir un accès à distance aux outils de collecte de données cliniques, numériser le résumé après la visite et ajouter des ressources sur l'auto-prise en charge de la douleur sur le site web de la clinique.Résultats: La Clinique de la douleur chronique a réussi à faire passer tous les rendez-vous de la clinique (multidisciplinaires et individuels; 77 rendez-vous) sur une période de deux semaines à des soins virtuels. Les cliniques virtuelles n'ont pas dépassé le temps habituel avant la COVID-19, ce qui indique que le flux de travail de la clinique était facilement adaptable aux soins virtuels.Conclusions: L'accès à des soins virtuels de qualité est essentiel pour éviter que la douleur chronique ne fasse des ravages dans la vie des patients et des familles. L'établissement rapide déune clinique virtuelle sans interruption dans la prestation des services aux patients est possible grâce à un soutien institutionnel et à une culture d'èquipe centrèe sur la collaboration et la souplesse.
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The Fontan operation remains the final palliation for thousands of patients with complex congenital heart disease. By creating a Fontan circuit, control of cardiac output and congestion is wrested away from the ventricle and new haemodynamic forces take control. Understanding how to control the flow in the Fontan circuit will enable clinicians to improve patient management and possibly prevent future complications. CONCLUSION: This review proposes a framework of principles to conceptualise the functionality and limitations of a Fontan circulation.
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Procedimiento de Fontan , Cardiopatías Congénitas , Gasto Cardíaco , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/cirugía , Hemodinámica , HumanosRESUMEN
BACKGROUND: To determine the feasibility and clinical result of selective embolization of hepatoduodenal or paratracheal lymphatics in Fontan patients with protein-losing enteropathy (PLE) or plastic bronchitis (PB). METHODS: Dilated lymph vessels in periportal (PLE) or paratracheal (PB) position were percutaneously punctured with a 22G Chiba needle. Intralymphatic position was confirmed by water soluble contrast injection with drainage to hepatoduodenal or tracheal fistulae. After flushing with 10% glucose solution, occlusion of hepatoduodenal or paratreacheal lymphatics was effected by injection of 1-4 cc mixture 4/1 of Lipiodol/n-butyl cyanoacrylate (n-BCA; Histoacryl). RESULTS: Seven patients with proven PLE were treated with periportal lymphatic embolization 10.7 (range: 6.6-13.5) years after the Fontan operation. The Fontan operation was performed at a median age of 3.7 (range: 2.9-5.7) years and PLE started a median of 3.1 (range: 0.9-4.7) years later. Five patients required a second procedure 2-8 months later. Complications were limited (spillage of glue in portal branch, transient cholangitis, and caustic duodenal bleeding). Six of seven patients reported significant improvement in quality of life and normalization of albumin levels after limited follow-up (p < .01). One patient (Fontan at 2.9 years; age 16.4 years) had PB for 2 years. Selective transthoracic cone-beam-directed puncture of left and right paratracheal lymphatics with n-BCA embolization of distal lymphatic fistulae resulted in lasting absence of tracheal casts (11 months). CONCLUSIONS: Embolization of periportal/peritracheal lymphatics is a promising technique in Fontan patients with PLE/PB. Larger series are required to determine incidence and reasons of success/failure, with long-term results and effects on liver function.
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Bronquitis/terapia , Embolización Terapéutica , Enbucrilato/administración & dosificación , Fístula/terapia , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Enfermedades Linfáticas/terapia , Enteropatías Perdedoras de Proteínas/terapia , Adolescente , Bronquitis/diagnóstico , Bronquitis/etiología , Niño , Embolización Terapéutica/efectos adversos , Enbucrilato/efectos adversos , Estudios de Factibilidad , Fístula/diagnóstico por imagen , Fístula/etiología , Humanos , Enfermedades Linfáticas/diagnóstico por imagen , Enfermedades Linfáticas/etiología , Enteropatías Perdedoras de Proteínas/diagnóstico , Enteropatías Perdedoras de Proteínas/etiología , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
Gut microbiota can have important effects on host health, but explanatory factors and pathways that determine gut microbial composition can differ among host lineages. In mammals, host phylogeny is one of the main drivers of gut microbiota, a result of vertical transfer of microbiota during birth. In birds, it is less clear what the drivers might be, but both phylogeny and environmental factors may play a role. We investigated host and environmental factors that underlie variation in gut microbiota composition in eight species of migratory shorebirds. We characterized bacterial communities from 375 fecal samples collected from adults of eight shorebird species captured at a network of nine breeding sites in the Arctic and sub-Arctic ecoregions of North America, by sequencing the V4 region of the bacterial 16S ribosomal RNA gene. Firmicutes (55.4%), Proteobacteria (13.8%), Fusobacteria (10.2%), and Bacteroidetes (8.1%) dominated the gut microbiota of adult shorebirds. Breeding location was the main driver of variation in gut microbiota of breeding shorebirds (R 2 = 11.6%), followed by shorebird host species (R 2 = 1.8%), and sampling year (R 2 = 0.9%), but most variation remained unexplained. Site variation resulted from differences in the core bacterial taxa, whereas rare, low-abundance bacteria drove host species variation. Our study is the first to highlight a greater importance of local environment than phylogeny as a driver of gut microbiota composition in wild, migratory birds under natural conditions.
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BACKGROUND AND AIMS: Suprasystemic pressure waves can damage the coronary arteries resulting in myocardial ischemia and excess early mortality. We aimed to reduce the coronary pressure wave through the sinusoids by abolishing RV volume with percutaneous devices. METHODS AND RESULTS: Four patients with PA-IVS and coronary sinusoids from the hypertensive rudimentary RV were evaluated at a median age 26.6 months (range: 2.7-51.7). Right ventricle coronary dependent flow to the left ventricular myocardium was excluded. All four patients had dual perfusion with competitive flow from the RV through the sinusoids to the coronary arteries. Devices used were: Amplatzer vascular plug II of 10-16 mm; 27 coils (diameter 5-15 mm) in the oldest patient. Right ventricular angiography after cavity obliteration showed no more significant coronary perfusion through the sinusoids. There were no complications or deaths. Only minor and transient changes in the levels of troponin were observed. Coronary angiography at pre-Fontan evaluation showed no progress of coronary abnormalities in two patients. CONCLUSION: In selected patients with functionally single left ventricle, obliteration of the hypertensive RV cavity by percutaneous devices is safe and abolishes the systolic pressure wave in coronary sinusoids. When performed early, this may halt coronary damage and avoid excess mortality.
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Cateterismo Cardíaco/instrumentación , Circulación Coronaria , Vasos Coronarios/fisiopatología , Cardiopatías Congénitas/terapia , Ventrículos Cardíacos/fisiopatología , Cuidados Paliativos , Atresia Pulmonar/terapia , Función Ventricular Derecha , Presión Ventricular , Preescolar , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/fisiopatología , Ventrículos Cardíacos/anomalías , Humanos , Lactante , Atresia Pulmonar/diagnóstico por imagen , Atresia Pulmonar/fisiopatología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Foetal ductal problems may have various cardiopulmonary consequences. This study aimed to identify the spectrum of ductus arteriosus (DA) dysfunction (closure, constriction, kinking, aneurysm and thrombosis) and the resultant clinical and echocardiographic presentation in foetuses and neonates. METHODS AND RESULTS: This is a retrospective analysis of serial pre- and post-natal data of 27 cases of foetal ductal dysfunction diagnosed at a median gestational age of 33 weeks (range 20-39). The most common abnormalities observed were premature closure of the DA in 56% (15/27) and constriction in 29% (8/27). Right ventricular hypertrophy was present in 75% (n = 11/15) of foetuses with premature DA closure, while ventricular dilation (4/7, 57%) was a more common feature in foetuses with ductal constriction. After birth, 63% (17/27) of new borns presented with cyanosis and pulmonary hypertension that required active treatment. Three infants died after birth. Abnormalities resolved spontaneously after birth in about 50% of patients. In some children, pulmonary valve stenosis and regurgitation was progressive and required further treatment. CONCLUSIONS: An abnormal right heart on foetal four-chamber ultrasound view should alert the sonographer to the possible presence of foetal ductal dysfunction. Ductal occlusion, transient or fixed constriction, kinking and aneurysm formation are associated with foetal cardiopulmonary sequelae. Symptoms and pathology is probably related to the type, foetal age, rapidity of progression and duration of intrauterine ductal dysfunction. Correspondingly, clinical outcomes vary ranging from little or no symptoms to severe respiratory distress and even foetal or neonatal death.
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Conducto Arterioso Permeable/fisiopatología , Conducto Arterial/diagnóstico por imagen , Función Ventricular Derecha/fisiología , Conducto Arterial/embriología , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/embriología , Ecocardiografía , Femenino , Estudios de Seguimiento , Edad Gestacional , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/embriología , Ventrículos Cardíacos/fisiopatología , Humanos , Recién Nacido , Embarazo , Estudios Retrospectivos , Ultrasonografía PrenatalRESUMEN
Objective The aim of the study was to assess the feasibility of using commonly available catheterization laboratory equipment for radiofrequency perforation of the pulmonary valve in patients with pulmonary atresia and intact ventricular septum. Methods The system (off-label use for all items) is made up of a co-axial telescopic arrangement consisting of a 0.014" PT 2 ™ coronary guidewire, for insulation inside a 2.7-F microcatheter which has an inner lumen of 0.021". The microcatheter was passed via a standard 4-F right coronary catheter to just below the atretic pulmonary valve. Radiofrequency (RF) energy was delivered using a standard electrosurgical system. In vitro testing had been performed and indicated that 5-10 W for 2-5 s would be sufficient for valve perforation. Results Radiofrequency perforation was successfully performed in all (n = 5, 100%) patients at a median age of 3â¯days (range: 1-36) and weight 2.7â¯kg (range 2.3-3.0). In one patient the pericardium was entered during the initial attempt; the generator was put on coagulation mode during retrieval of the guidewire and no haemopericardium occurred. The pulmonary valve was dilated in all; in three patients (n = 3) the ductus arteriosus was stented during the same session. Conclusion Results of the study show that it is feasible to perforate the pulmonary valve safely using this system. Availability, simplicity and cost are noteworthy benefits.
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Angioplastia de Balón , Ablación por Catéter , Cardiopatías Congénitas/cirugía , Atresia Pulmonar/cirugía , Válvula Pulmonar/cirugía , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/economía , Angioplastia de Balón/instrumentación , Catéteres Cardíacos , Ablación por Catéter/efectos adversos , Ablación por Catéter/economía , Ablación por Catéter/instrumentación , Angiografía Coronaria , Análisis Costo-Beneficio , Estudios de Factibilidad , Femenino , Costos de la Atención en Salud , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/economía , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Atresia Pulmonar/diagnóstico por imagen , Atresia Pulmonar/economía , Atresia Pulmonar/fisiopatología , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Stents , Resultado del TratamientoRESUMEN
Introduction In traditional locations, the standard Blalock-Taussig shunt presents numerous technical difficulties for percutaneous intervention. We changed our strategy to a central type shunt (Laks-type) with end-to-side pulmonary and side-to-side aortic anastomosis. The aim of this study was to determine whether this modified strategy would allow easier percutaneous manipulation in patients with small pulmonary arteries. Methods All children with a stretchable central vascular graft who required any form of percutaneous intervention were prospectively enrolled in the study. Results Eleven infants were evaluated a median time of 3 months (range 0.9-4.4) following initial shunt placement; the median weight at intervention was 5.7 kg (range: 4.0 - 10.0). All shunts (100%) were easily and swiftly entered without the need for special catheters or co-axial systems. In four patients other interventions in distal pulmonary arteries were first performed: cutting balloon treatment in three and balloon angioplasty of peripheral pulmonary artery stenosis in one. The shunts were then augmented with a stent with a diameter increasing from 3.5 ± 0.4 mm to 4.7 ± 0.8 mm and saturation increasing from 76% (range: 69-88) to 84% (range: 77-88) (P < 0.05). Several months later, two children required further interventions that could easily be performed via the stented shunts. No complications were observed. Conclusions The Laks-type shunt provides easy access for percutaneous procedures of the distal pulmonary arteries including cutting balloons; this shunt can predictably be expanded to augment pulmonary flow. This study highlights how co-operation between the interventionalist and the surgeon can improve strategies to manage these difficult patients.
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Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Cateterismo Cardíaco/métodos , Guías de Práctica Clínica como Asunto , Arteria Pulmonar/cirugía , Stents , Angiografía , Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/normas , Cateterismo Cardíaco/normas , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Masculino , Estudios Prospectivos , Diseño de Prótesis , Arteria Pulmonar/diagnóstico por imagen , Resultado del TratamientoRESUMEN
OBJECTIVE: To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database. PATIENTS AND METHODS: This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported. RESULTS: In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group. CONCLUSION: S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
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Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Próstata/cirugía , Ultrasonido Enfocado Transrectal de Alta Intensidad , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Pronóstico , Neoplasias de la Próstata/radioterapia , Estudios Retrospectivos , Terapia Recuperativa , Insuficiencia del Tratamiento , Ultrasonido Enfocado Transrectal de Alta Intensidad/efectos adversosRESUMEN
BACKGROUND: Lack of data exists on the surgical management of adult congenital heart disease on the African continent. This study was undertaken to describe the clinical profile and surgical outcome of adult patients with congenital heart disease undergoing surgery in a single-center African study population. METHODS: A retrospective medical chart review of consecutive adult patients (≥18 years) undergoing congenital heart surgery between October 1995 and December 2015 at our institution was undertaken. We described cardiac diagnosis, diagnostic complexity, risk profile, and surgical morbidity and mortality. RESULTS: Data were collected of 233 surgical procedures performed in 219 patients (45.6% males). The most common diagnostic category was septal defects (41.2%), followed by right heart lesions (17.2%), left heart lesions (12.4%), thoracic arteries (9.0%), and conduit failure (6.9%). Twenty-four percent of patients presented in functional class III or IV, and 46% of patients met the criteria for the simple Bethesda diagnostic class. Preoperative risk factors were identified in 19.8% of patients. Corrective surgery was performed in 71.7% of cases, reoperative surgery in 27.6%, and palliative surgery in 0.8%. Right ventricle to pulmonary artery conduit placement comprised 53.1% of reoperations. The overall hospital mortality was 1.7%. Postoperative complications occurred in 26.3% of cases. CONCLUSIONS: This study presents a detailed description of this emerging population in a developing world context. Our outcomes data suggest that adult congenital heart disease surgery is feasible in a Southern African tertiary referral center with low operative mortality and acceptable morbidity.