Techniques for Cardiac Resynchronization Therapy in Patients with Congenital Heart Disease.

Cardiac resynchronization therapy (CRT) for congenital heart disease has shown promising suucess as an adjunct to medical therapy for heart failure. While cardiac conduction defects and need for ventricular pacing are common in congential heart disease, CRT indications, techniques and long term outcomes have not been well establaished. This is a review of the techniques nad short term outcomes of CRT for the following complex congenital heart disease conditions: single ventricle physiology, systemic right ventricle, and the subpulmonic right ventricle.

Metal-specific biomagnification and trophic dilution in the coastal foodweb of the California sea lion (Zalophus californianus) off Bahía Magdalena, Mexico: The role of the benthic-pelagic foodweb in the trophic transfer of trace and toxic metals.

Trace metals concentrations along with stable isotopes ratios were measured in marine algae, sea grass, sponges, echinoderms, mollusks, crustaceans, fishes, and the California sea lion, to assess the bioaccumulation potential and detect potential risks for top predators off Bahia Magdalena, Mexico. We assessed the trophic magnification factor (TMF) to determine the potential for biomagnification of 11 trace metals. The concentrations of Fe and Zn were one order of magnitude higher than all other metals. Concentrations of As, Cu, Cd, Co, Cr, Fe, Mn and Ni correlated negatively with trophic level, supporting trophic dilution (TMF < 1, p > 0.05), while Zn and Hg had significant trophic magnification (TMF > 1, p < 0.05) when assessing only the benthic-pelagic foodweb. This research provides a baseline concentration of metals in multiple species, metal-specific foodweb bioaccumulation and biomagnification of mercury, underscoring the key role of the macrobenthic community as biovectors for trophic transfer of Hg through the foodweb to the California sea lion.

Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children.

INTRODUCTION: Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT. METHODS: We identified hospital-based care episodes of children 0-18 years old between 2006 and 2015 recorded in the Intermountain Healthcare EDW with either 1) diagnosis codes for both asthma and SVT or 2) both SABA and adenosine listed as billed medications. Controls were matched with cases by age and sex to determine risk factors for SVT after SABA using conditional logistic regression. RESULTS: Of 93 care episodes meeting criteria, we found 7 cases of SVT after SABA treatment in 6 patients over 10 years. In our population, the incidence of SVT is 3.9 per 10,000 episodes of SABA treatment, and 5.1 per 10,000 children with asthma receiving hospital-based asthma care. Two episodes of SVT followed treatment with only levalbuterol, three after only albuterol, and two after both albuterol and levalbuterol treatment. Five cases of SVT were converted to sinus rhythm with adenosine, one converted with synchronized electrical cardioversion, and one resolved spontaneously. No cases of SVT led to death. No examined variables were associated with SABA-induced SVT. CONCLUSIONS: SVT is rare during hospital-based treatment for acute asthma using inhaled SABAs and has low morbidity and mortality.

Determinants of genetic variation across eco-evolutionary scales in pinnipeds.

The effective size of a population (Ne), which determines its level of neutral variability, is a key evolutionary parameter. Ne can substantially depart from census sizes of present-day breeding populations (NC) as a result of past demographic changes, variation in life-history traits and selection at linked sites. Using genome-wide data we estimated the long-term coalescent Ne for 17 pinniped species represented by 36 population samples (total n = 458 individuals). Ne estimates ranged from 8,936 to 91,178, were highly consistent within (sub)species and showed a strong positive correlation with NC ([Formula: see text] = 0.59; P = 0.0002). Ne/NC ratios were low (mean, 0.31; median, 0.13) and co-varied strongly with demographic history and, to a lesser degree, with species' ecological and life-history variables such as breeding habitat. Residual variation in Ne/NC, after controlling for past demographic fluctuations, contained information about recent population size changes during the Anthropocene. Specifically, species of conservation concern typically had positive residuals indicative of a smaller contemporary NC than would be expected from their long-term Ne. This study highlights the value of comparative population genomic analyses for gauging the evolutionary processes governing genetic variation in natural populations, and provides a framework for identifying populations deserving closer conservation attention.

Trace elements in marine organisms of Magdalena Bay, Pacific Coast of Mexico: Bioaccumulation in a pristine environment.

Trace element (Fe, Mn, Cr, Cu, Ni, Co, Pb, Zn, Cd, As, Hg) concentrations were assessed in marine organisms (n = 52) sampled from the Magdalena Bay lagoon complex in Baja California Sur, Mexico, a pristine marine environment. The overall trend of metal concentrations (dry weight) in the organisms was found to be Fe > Zn > Cd > Cu > Mn > Pb > As > Hg > Ni > Cr > Co. Bivalve mollusks (53.83 mg kg-1) contained twofold higher levels of metals than the finfishes (20.77 mg kg-1). Calculated BioConcentration Factor (BCF) values showed that dissolved Mn is readily bioavailable to the organisms, whereas Biota Sediment Accumulation Factor (BSAF) indicated high values for Zn, Cu and Cd. Cd and As levels were observed to be increasing with the trophic levels. Toxic elements, namely Pb, Cd and As in the studied fish species were found to be higher than the values recommended for human seafood consumption. The study provides a comprehensive baseline report on trace element bioaccumulation in several marine organisms that will aid in developing effective conservation strategies of the highly biodiverse lagoon complex.

Vibrissa growth rate in California sea lions based on environmental and isotopic oscillations.

Pinniped vibrissae provide information on changes in diet at seasonal and annual scales; however, species-specific growth patterns must first be determined in order to interpret these data. In this study, a simple linear model was used to estimate the growth rate of vibrissae from adult female California sea lions (Zalophus californianus) from San Esteban Island in the Gulf of California, Mexico. The δ15N and δ13C values do not display a marked oscillatory pattern that would permit direct determination of the time period contained in each vibrissa; thus, time (age) was calculated in two ways: 1) based on the correlation between the observed number of peaks (Fourier series) in the δ15N profile and the length of each vibrissa, and 2) through direct comparison with the observed number of peaks in the δ15N profile. Cross-correlation confirmed that the two peaks in the δ15N profile reflected the two peaks in the chlorophyll-a concentration recorded annually around the island. The mean growth rate obtained from the correlation was 0.08 ± 0.01 mm d-1, while that calculated based on the observed number of peaks was 0.10 ± 0.05 mm d-1. Both are consistent with the rates reported for adult females of other otariid species (0.07 to 0.11 mm d-1). Vibrissa growth rates vary by individual, age, sex, and species; moreover, small differences in the growth rate can result in significant differences over the time periods represented by the isotopic signal. Thus, it is important to assess this parameter on a species-by-species basis.

Ecological efficiency of finite-time thermodynamics: A molecular dynamics study.

We present a molecular dynamics simulation of a two-dimensional Carnot engine. The optimization of this engine is achieved through the velocity of the piston, allowing not only the optimization of power output but also some other figures of merit involving entropy production. The maximum power and maximum ecological efficiencies are computed. It is shown that the near ideal gas working substance displays an endoreversible Carnot-like engine behavior. This can be considered as a prove of the validity of the Carnot-like endoreversible model. An effective reversible cycle different than the Carnot one is obtained, in agreement with the endoreversible hypothesis flexibility. We compare the efficiencies stemming from an ideal gas approximation with those of the simulation, and then we propose a suitable approximation to an endoreversible heat engine and to a reversible Joule-Brayton cycle which fits very well to the simulation results. Finally, we show that the maximum ecological efficiency η=1-τ^{3/4}, which is also very close to the upper bound of the low-dissipation heat engine under maximum ecological (and Omega) conditions, is close for describing the dynamics of the simulated cycle under maximum power and maximum ecological conditions in the so-named heat engine operability region.

Electrocardiograms in Healthy North American Children in the Digital Age.

BACKGROUND: Interpretation of pediatric ECGs is limited by lack of accurate sex- and race-specific normal reference values obtained with modern technology for all ages. We sought to obtain contemporary digital ECG measurements in healthy children from North America, to evaluate the effects of sex and race, and to compare our results to commonly used published datasets. METHODS: Digital ECGs (12-lead) were retrospectively collected for children ≤18 years old with normal echocardiograms at 19 centers in the Pediatric Heart Network. Patients were classified into 36 groups: 6 age, 2 sex, and 3 race (white, black, and other/mixed) categories. Standard intervals and amplitudes were measured; mean±SD and 2nd/98th percentiles were determined by age group, sex, and race. For each parameter, multivariable analysis, stratified by age, was conducted using sex and race as predictors. Parameters were compared with 2 large pediatric ECG data sets. RESULTS: Among ECGs from 2400 children, significant differences were found by sex and race categories. The corrected QT interval in lead II was greater for girls compared with boys for age groups ≥3 years (P≤0.03) and for whites compared with blacks for age groups ≥12 years (P<0.05). The R wave amplitude in V6 was greater for boys compared with girls for age groups ≥12 years (P<0.001), for blacks compared with white or other race categories for age groups ≥3 years (P≤0.006), and greater compared with a commonly used public data set for age groups ≥12 years (P<0.0001). CONCLUSIONS: In this large, diverse cohort of healthy children, most ECG intervals and amplitudes varied by sex and race. These differences have important implications for interpreting pediatric ECGs in the modern era when used for diagnosis or screening, including thresholds for left ventricular hypertrophy.

Expanding the application scope of on-farm biopurification systems: Effect and removal of oxytetracycline in a biomixture.

Antibiotic-containing wastewaters produced in agricultural activities may depress the pesticide-degrading capacity of biomixtures contained in biopurification systems. This work aimed to assay the effect of oxytetracycline (OTC) on the removal of carbofuran (CFN) in an optimized biomixture, and to determine the capacity of the system to dissipate OTC. During co-application of CFN+OTC, CFN removal and its accelerated degradation were not negatively affected. Similarly, different doses of OTC (10-500mgkg-1) did not significantly affect CFN mineralization, and the process even exhibited a hormetic-like effect. Moreover, the biomixture was able to remove OTC with a half-life of 34.0 d. DGGE-cluster analyses indicated that fungal and bacterial communities remained relatively stable during OTC application and CFN+OTC co-application, with similarities of over 70% (bacteria) and 80% (fungi). Overall, these findings support the potential use of this matrix to discard OTC-containing wastewater in this system originally intended for CFN removal.

Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network.

OBJECTIVES: The study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality. METHODS: After excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors. RESULTS: Tachyarrhythmias were noted in 20% of subjects, and atrioventricular block was noted in 4% of subjects. Potentially significant risk factors for tachyarrhythmia included the presence of modified Blalock-Taussig shunt (P = .08) and age at Norwood (P = .07, with risk decreasing each day at age 8-20 days); the only significant risk factor for atrioventricular block was undergoing a concomitant procedure at the time of the Norwood (P = .001), with the greatest risk being in those undergoing a tricuspid valve procedure. Both tachyarrhythmias and atrioventricular block were associated with longer ventilation time and length of stay (P < .001 for all analyses). Tachyarrhythmias were not associated with interstage mortality; atrioventricular block was associated with mortality among those without a pacemaker in the unadjusted analysis (hazard ratio, 2.3; P = .02), but not after adding covariates. CONCLUSIONS: Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.

Management of hypoplastic left heart syndrome with intact atrial septum: a two-centre experience.

UNLABELLED: Introduction Hypoplastic left heart syndrome with an intact atrial septum is a poor predictor of outcomes. Prenatal assessment of pulmonary venous Doppler and emergent postnatal cardiac intervention may be associated with better outcomes. Materials and methods A retrospective review of all hypoplastic left heart syndrome patients in two centres over a 5-year period was performed. Group 1 included patients with adequate inter-atrial communication. Group 2 included patients with prenatal diagnosis with an intact atrial septum who had immediate transcatheter intervention. Group 3 included patients with intact atrial septum who were not prenatally diagnosed and underwent either delayed intervention or no intervention before stage 1 palliation. Primary outcome was survival up to stage 2 palliation. RESULTS: The incidence of hypoplastic left heart syndrome with a restrictive atrial communication was 11.2% (n=19 of 170). Overall survival to stage 2 or heart transplantation was 85% and 67% for Groups 1 and 2, respectively (n=129/151, n=8/12; p=0.03), and 0% (n=0/7) for Group 3. Survival benefits were observed between Groups 2 and 3 (p<0.001). Foetal pulmonary vein Doppler reverse/forward velocity time integral ratio of ⩾18% (sensitivity, 0.99, 95% CI, 0.58-1; specificity, 0.99, 95% CI, 0.96-1) was predictive of the need for emergent left atrial decompression. CONCLUSION: Using a multidisciplinary approach and foetal pulmonary vein Doppler, time-saving measures can be instituted by delivering prenatally diagnosed neonates with hypoplastic left heart syndrome with intact atrial septum close to the cardiac catheterisation suite where left atrial decompression can be performed quickly and safely that may improve survival.

The Use of Surrogate Data in Demographic Population Viability Analysis: A Case Study of California Sea Lions.

Reliable data necessary to parameterize population models are seldom available for imperiled species. As an alternative, data from populations of the same species or from ecologically similar species have been used to construct models. In this study, we evaluated the use of demographic data collected at one California sea lion colony (Los Islotes) to predict the population dynamics of the same species from two other colonies (San Jorge and Granito) in the Gulf of California, Mexico, for which demographic data are lacking. To do so, we developed a stochastic demographic age-structured matrix model and conducted a population viability analysis for each colony. For the Los Islotes colony we used site-specific pup, juvenile, and adult survival probabilities, as well as birth rates for older females. For the other colonies, we used site-specific pup and juvenile survival probabilities, but used surrogate data from Los Islotes for adult survival probabilities and birth rates. We assessed these models by comparing simulated retrospective population trajectories to observed population trends based on count data. The projected population trajectories approximated the observed trends when surrogate data were used for one colony but failed to match for a second colony. Our results indicate that species-specific and even region-specific surrogate data may lead to erroneous conservation decisions. These results highlight the importance of using population-specific demographic data in assessing extinction risk. When vital rates are not available and immediate management actions must be taken, in particular for imperiled species, we recommend the use of surrogate data only when the populations appear to have similar population trends.

Metal concentrations in demersal fish species from Santa Maria Bay, Baja California Sur, Mexico (Pacific coast).

Concentrations of 11 trace metals (Fe, Mn, Cr, Cu, Ni, Co, Pb, Zn, Cd, As, Hg) in 40 fish species from Santa Maria Bay, Baja California Sur, Mexico, the strategically important area for marine mammals and organisms were analyzed. Based on their concentrations the ranking of metals Fe>Zn>Ni>Cr>Mn>Pb>Cu>Co>As>Cd>Hg suggests that organism size, metabolism and feeding habits are correlated with metal concentrations. Local geological formations affect the concentrations of different metals in the aquatic environment and are subsequently transferred to fishes. The correlation analysis suggests that metabolism and nurturing habits impact the concentration of metals. Concentrations of Fe and Mn appear to be influenced by scavenging and absorption processes, which vary by species. The considerable variability in the metal concentrations obtained in different species underscores the importance of regular monitoring.

Infection of California sea lions (Zalophus californianus) with terrestrial Brucella spp.

Infections with Brucella ceti and pinnipedialis are prevalent in marine mammals worldwide. A total of 22 California sea lions (Zalophus californianus) were examined to determine their exposure to Brucella spp. at San Esteban Island in the Gulf of California, Mexico, in June and July 2011. Although samples of blood, vaginal mucus and milk cultured negative for these bacteria, the application of rose Bengal, agar gel immunodiffusion, PCR and modified fluorescence polarization assays found that five animals (22.7%) had evidence of exposure to Brucella strains. The data also suggested that in two of these five sea lions the strains involved were of terrestrial origin, a novel finding in marine mammals. Further work will be required to validate and determine the epidemiological significance of this finding.

Timing of isotopic integration in marine mammal skull: comparative study between calcified tissues.

RATIONALE: Tissues with different turnover rates have different isotope compositions and reflect the different periods in an animal's life when the isotopes are incorporated during the growth of tissues. Bone is one of the most used tissues for reconstruction of an animal's diet; however, the time of isotope integration remains unknown for many species. METHODS: The δ(15)N and δ(13)C values in tooth dentine and bone tissue from the maxilla and mandible of 21 stranded northern elephant seals, Mirounga angustirostris, collected on the San Benito and Magdalena Islands, Mexico, between 2000 and 2008 were compared. Bone and dentine samples from each growth layer within the tooth were analyzed using a PDZ Europa ANCA-GSL elemental analyzer interfaced with a PDZ Europa 20-20 continuous flow gas source mass spectrometer. RESULTS: The δ(15)N and δ(13)C values were not different between bone structures, indicating similar turnover rates, metabolic activity and amino acid compositions. The differences in the observed δ(13)C values between tissues are probably indicative of differences in their amino acid compositions, although the similarities in δ(15)N values indicated less variation from different amino acids. Correlation of the analyses between isotopic values of tissues suggests that the maxilla and/or mandible of M. angustirostris might reflect the δ(15) N signal incorporated during the last 5 years of life of the individuals. CONCLUSIONS: This study demonstrated the usefulness of the applied approach for providing a best approximation of the timing of isotopic integration into the skull of a marine mammal, thereby reducing uncertainty in exploring historic changes in the species' feeding behavior.

Polychlorinated biphenyls and polybrominated diphenyl ethers in Galapagos sea lions (Zalophus wollebaeki).

Concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) were measured in muscle-blubber biopsy samples from 21 Galapagos sea lion (Zalophus wollebaeki) pups that were live captured in the Galapagos Islands (Ecuador) using gas chromatography/high-resolution mass spectrometry. Only traces of PBDEs were detected in one male pup, whereas PCDDs and PCDFs were not detected in any sample. The total concentration of PCBs (ΣPCB) in the pups averaged 104 µg/kg lipid (range, 49-384 µg/kg). No statistically significant differences in ΣPCB were observed among the four study sites in the Galapagos Islands. Concentrations of PCB congeners in Galapagos sea lion pups were dominated by low-molecular-weight congeners. These results suggest that global transport is the main source for PCBs in Galapagos sea lions. The ΣPCB levels were below immunotoxic and endocrine-disruption thresholds in pinnipeds, suggesting a limited risk of adverse health effects. The present study indicates that Galapagos sea lions can serve as a useful sentinel of pollutants with a long-range transport capacity and that Galapagos Islands are not exempt from the threats of global pollutants despite its remote locale.