Mitral valve repair in children with rheumatic heart disease.

PURPOSE: Rheumatic heart disease is the most common acquired heart disease in children in developing countries. The heart valve lesions produce severe hemodynamic changes due to scarring of the valves over time. Around 15.6 million people are affected by rheumatic heart disease (RHD), and 230,000 die around the globe annually. Valve repair should be the primary goal, although it is technically challenging because of the fact that rheumatic process evolves making repair outcomes variable. METHODS: We reviewed the literature for the various techniques done for mitral valve repair in children with rheumatic heart disease. Early and late results of repair were compared with the results found for mitral valve repair done for such children. RESULTS: Prosthetic heart valve implantation in children has major negative impact on their immediate- and long-term survival as well as on quality of their life. Valve repair is associated with improved ventricular function because the normal valve tissue and subvalvular apparatus are preserved, reduced complications related to prosthetic valve, and lower in-hospital and late mortality. CONCLUSION: In children, the results of mitral valve replacement were found to be inferior to those of mitral valve repair. The reoperation rates are similar in patients undergoing initial repair or replacement, which favors repair as an option. In developing world, rheumatic mitral valve disease is more prevalent where adequate facilities for monitoring of prosthetic valve function and management of anticoagulation therapy are not easily available. Valve repair therefore should be the primary goal.

Neonatal ascending aorta thrombosis: A rare and lethal entity.

Ascending aorta thrombosis (AAT) in a neonate is a rare and lethal event. To date, AAT has been reported in around 25 patients, out of whom only eight patients had concomitant arch involvement. We report a case of one such patient with ascending aorta and arch thrombosis and present a brief review of the available literature.

Left Bidirectional Cavopulmonary Connection in Raghib's Defect: Report of 5 Cases and Review of Literature.

We report five male patients aged 3, 6, 8, 10, and 15 years, respectively, undergoing left bidirectional cavopulmonary connection and concomitant Dacron patch closure of the atrial septal defect for Raghib's defect with persistent left superior vena cava. The circulation was successfully corrected. This extracardiac procedure uses only autogenous tissues having growth potential, reduces myocardial ischemia, and avoids later baffle deterioration with pulmonary venous obstruction associated with intra-atrial baffling procedures. A wider appreciation and application of this management modality is warranted.

Left isomerism with bilateral superior vena cava, interrupted inferior vena cava and tetralogy of Fallot.

The association of left isomerism with tetralogy of Fallot (TOF) is rare and reported as scattered case reports. Complex congenital cardiac and noncardiac malformations are known to be associated with left isomerism, but right-sided obstructive lesions are rare. We present our experience with a case of left isomerism with bilateral superior vena cava, interrupted inferior vena cava, and TOF managed by atrial septation and intracardiac repair.

Audit of homograft valve bank.

INTRODUCTION: Even today, the search for the ideal cardiac valve continues. With advantages of having superior flow dynamics, avoidance of anticoagulation, and resistance to infection, homograft has been shown to have an edge over conventional prosthetic and bioprosthetic valves. But they suffer from disadvantages of limited availability and durability. Our center operates one of the oldest functioning valve banks in the country. We present our experience with homograft valve banking with antibiotic and cryopreserved homografts spread over a quarter century. METHODS: For donor selection, procurement, sterilization, and preservation, the recommendations of the American Association of Tissue Banks are being followed in accordance with statutory provisions of the Transplantation of Human Organs Act, 1994. RESULTS: During 25-year period (1993-2017), 777 hearts were procured. Age of the donors ranged from 2 to 60 years and hearts were procured within 24 h of death. A total of 1646 homografts (774 pulmonary, 774 aortic, 60 mitral valves, 20 descending thoracic aortae, and 18 monocusps) were harvested. A total of 546 (32%) homografts were rejected for various reasons. Nine hundred sixty-seven (56.7%) homografts were used in different procedures. Of these, 478 were pulmonary homografts, 425 were aortic homografts, 39 mitral homografts, 18 monocusps, and 7 descending thoracic aorta homografts. One hundred fifty-four (16%) homografts were antibiotic preserved and the rest 813 (84%) were cryopreserved. CONCLUSIONS: It is possible to run a homograft valve bank with minimum costs. Though, cryopreservation is more expensive, it provides an opportunity to store the valves for an indefinite period and maintain an uninterrupted supply of homografts.

Pulmonary root translocation and Senning procedure for congenitally corrected transposition of great arteries with pulmonary stenosis: a case report.

Congenitally corrected transposition of the great arteries (CCTGAs) is a condition, which includes atrioventricular and ventriculoarterial discordant connections along with ventricular septal defect (VSD), pulmonary stenosis (PS), or pulmonary atresia (PA). Without treatment, progressive systemic ventricular failure begins, which is followed by sudden cardiac death by the fourth or fifth decade. We report a case of a 4-year-old with CCTGA, VSD, and PS operated by Senning procedure and pulmonary root translocation (PRT) with uneventful postoperative recovery. PRT overcomes problems with the right ventricle to the pulmonary artery conduit and maintains pulmonary valve function and growth capacity. Our initial experience with PRT in CCTGA indicates that it is a feasible surgical alternative for such patients.

New Tools and Connections for Exponential-Time Approximation.

In this paper, we develop new tools and connections for exponential time approximation. In this setting, we are given a problem instance and an integer r > 1 , and the goal is to design an approximation algorithm with the fastest possible running time. We give randomized algorithms that establish an approximation ratio ofr for maximum independent set in O ∗ ( exp ( O ~ ( n / r log 2 r + r log 2 r ) ) ) time,r for chromatic number in O ∗ ( exp ( O ~ ( n / r log r + r log 2 r ) ) ) time, ( 2 - 1 / r ) for minimum vertex cover in O ∗ ( exp ( n / r Ω ( r ) ) ) time, and ( k - 1 / r ) for minimum k-hypergraph vertex cover in O ∗ ( exp ( n / ( k r ) Ω ( k r ) ) ) time. (Throughout, O ~ and O ∗ omit polyloglog ( r ) and factors polynomial in the input size, respectively.) The best known time bounds for all problems were O ∗ ( 2 n / r ) (Bourgeois et al. in Discret Appl Math 159(17):1954-1970, 2011; Cygan et al. in Exponential-time approximation of hard problems, 2008). For maximum independent set and chromatic number, these bounds were complemented by exp ( n 1 - o ( 1 ) / r 1 + o ( 1 ) ) lower bounds (under the Exponential Time Hypothesis (ETH)) (Chalermsook et al. in Foundations of computer science, FOCS, pp. 370-379, 2013; Laekhanukit in Inapproximability of combinatorial problems in subexponential-time. Ph.D. thesis, 2014). Our results show that the naturally-looking O ∗ ( 2 n / r ) bounds are not tight for all these problems. The key to these results is a sparsification procedure that reduces a problem to a bounded-degree variant, allowing the use of approximation algorithms for bounded-degree graphs. To obtain the first two results, we introduce a new randomized branching rule. Finally, we show a connection between PCP parameters and exponential-time approximation algorithms. This connection together with our independent set algorithm refute the possibility to overly reduce the size of Chan's PCP (Chan in J. ACM 63(3):27:1-27:32, 2016). It also implies that a (significant) improvement over our result will refute the gap-ETH conjecture (Dinur in Electron Colloq Comput Complex (ECCC) 23:128, 2016; Manurangsi and Raghavendra in A birthday repetition theorem and complexity of approximating dense CSPs, 2016).

Anatomical Variations of Cerebral MR Venography: Is Gender Matter?

PURPOSE: Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. MATERIALS AND METHODS: A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. RESULTS: A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. CONCLUSION: Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

Approximating Vector Scheduling: Almost Matching Upper and Lower Bounds.

We consider the Vector Scheduling problem, a natural generalization of the classical makespan minimization problem to multiple resources. Here, we are given n jobs, represented as d-dimensional vectors in [ 0 , 1 ] d , and m identical machines, and the goal is to assign the jobs to machines such that the maximum load of each machine over all the coordinates is at most 1. For fixed d, the problem admits an approximation scheme, and the best known running time is n f ( ϵ , d ) where f ( ϵ , d ) = ( 1 / ϵ ) O ~ ( d ) ( O ~ suppresses polylogarithmic terms in d). In particular, the dependence on d is double exponential. In this paper we show that a double exponential dependence on d is necessary, and give an improved algorithm with essentially optimal running time. Specifically, we let exp ( x ) denote 2 x and show that: (1) For any ϵ < 1 , there is no ( 1 + ϵ ) -approximation with running time exp o ( ⌊ 1 / ϵ ⌋ d / 3 ) unless the Exponential Time Hypothesis fails. (2) No ( 1 + ϵ ) -approximation with running time exp ⌊ 1 / ϵ ⌋ o ( d ) exists, unless NP has subexponential time algorithms. (3) Similar lower bounds also hold even if ϵ m extra machines are allowed (i.e. with resource augmentation), for sufficiently small ϵ > 0 . (4) We complement these lower bounds with a ( 1 + ϵ ) -approximation that runs in time exp ( 1 / ϵ ) O ( d log log d ) + n d . This gives the first efficient approximation scheme (EPTAS) for the problem.

Evaluation of the effect of scleral buckling on the anterior chamber angle using ASOCT.

PURPOSE: To evaluate the change in anterior chamber angle parameters after scleral buckling surgery using anterior segment optical coherence tomography (ASOCT). METHODS: Fifty-five phakic eyes of 55 subjects undergoing scleral buckling with the placement of an encircling band for primary rhegmatogenous retinal detachment were included in this study. Anterior chamber angle assessment was performed using ASOCT. The trabecular iris angle (TIA), the angle-opening distance, and the trabecular iris space area were the parameters obtained preoperatively and 48 hours, 1 week, and 1 month after the surgery using ASOCT. The intraocular pressure (IOP) was measured using Goldmann applanation tonometry. RESULTS: The mean age of the patients was 43.2±11.3 years; there were 38 male and 17 female patients. There was a significant decrease in all the angle parameters (TIA, angle opening distance, and trabecular iris space area) at 48 hours, 1 week, and 1 month after surgery (P<0.0001). TIA 180 degree decreased from 41.93±14.27 degrees preoperatively to 31.09±10.52 degrees (P<0.0001) and TIA 0 degree from 42.7±14.04 degrees to 32.92±12.17 degrees (P<0.0001) at 48 hours postoperatively. The mean IOP at 48 hours (17.04±3.26 mm Hg) was significantly higher than the preoperative level (12.68±1.96 mm Hg; P<0.001). No significant difference was noted between the mean preoperative IOP and the IOP readings at 1 week (P=0.402) and 1 month (P=0.23) postoperatively. CONCLUSIONS: ASOCT imaging reveals that scleral buckling surgery for retinal detachment induces significant narrowing of the anterior chamber angle.

Recent advances in imaging technologies in dentistry.

Dentistry has witnessed tremendous advances in all its branches over the past three decades. With these advances, the need for more precise diagnostic tools, specially imaging methods, have become mandatory. From the simple intra-oral periapical X-rays, advanced imaging techniques like computed tomography, cone beam computed tomography, magnetic resonance imaging and ultrasound have also found place in modern dentistry. Changing from analogue to digital radiography has not only made the process simpler and faster but also made image storage, manipulation (brightness/contrast, image cropping, etc.) and retrieval easier. The three-dimensional imaging has made the complex cranio-facial structures more accessible for examination and early and accurate diagnosis of deep seated lesions. This paper is to review current advances in imaging technology and their uses in different disciplines of dentistry.

Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound: a proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index.

OBJECTIVES: To assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. METHODS: Data from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging. RESULTS: Of the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed. Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. CONCLUSIONS: B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

Schizencephaly of open and closed lip type in the same patient: An extremely rare occurrence.

Neuronal migration defects are rare causes of seizure disorder and developmental problems. Schizencephaly the most severe form is an extremely rare entity. Here a rare case of bilateral schizencephaly (open and closed type in the same patient) is reported.

Mechanisms of transcriptional modulation of the human anion exchanger SLC26A3 gene expression by IFN-{gamma}.

Two members of the SLC26 gene family, SLC26A3 or DRA (downregulated in adenoma) and SLC26A6 (putative anion transporter 1, PAT1), are known to play a major role in apical Cl(-)/OH(-) (HCO(3)(-)) exchange process in the human intestine. We have previously shown the inhibitory effects of IFN-gamma (30 ng/ml, 24 h) on both SLC26A3 and A6 expression and promoter activity. We also demonstrated that the effects of IFN-gamma on SLC26A6 gene expression were mediated via IRF-1 transcription factor. However, the molecular mechanisms underlying the transcriptional modulation of SLC26A3 gene expression by IFN-gamma in the intestine are not known. The present studies were, therefore, designed to elucidate the signaling mechanisms and transcription factor(s) involved in mediating the inhibitory effects of IFN-gamma on DRA promoter (p--1183/+114) activity. Deletion analysis indicated that the IFN-gamma response element is located within the -1183 to -790 region, and sequence analysis of this region revealed the presence of potential gamma-activated site (GAS), a binding site (-933/-925 bp) for signal transducer and activator of transcription factor 1 (STAT1). Mutations in the potential GAS element abrogated the inhibitory effects of IFN-gamma. These studies provide evidence for the involvement of STAT1 in the inhibition of SLC26A3 gene expression by IFN-gamma in the human intestine.

Mechanisms underlying modulation of monocarboxylate transporter 1 (MCT1) by somatostatin in human intestinal epithelial cells.

Somatostatin (SST), an important neuropeptide of the gastrointestinal tract has been shown to stimulate sodium chloride absorption and inhibit chloride secretion in the intestine. However, the effects of SST on luminal butyrate absorption in the human intestine have not been investigated. Earlier studies from our group and others have shown that monocarboxylate transporter (MCT1) plays an important role in the transport of butyrate in the human intestine. The present studies were undertaken to examine the effects of SST on butyrate uptake utilizing postconfluent human intestinal epithelial Caco2 cells. Apical SST treatment of Caco-2 cells for 30-60 min significantly increased butyrate uptake in a dose-dependent manner with maximal increase at 50 nM ( approximately 60%, P < 0.05). SST receptor 2 agonist, seglitide, mimicked the effects of SST on butyrate uptake. SST-mediated stimulation of butyrate uptake involved the p38 MAP kinase-dependent pathway. Kinetic studies demonstrated that SST increased the maximal velocity (V(max)) of the transporter by approximately twofold without any change in apparent Michaelis-Menten constant (K(m)). The higher butyrate uptake in response to SST was associated with an increase in the apical membrane levels of MCT1 protein parallel to a decrease in the intracellular MCT1 pool. MCT1 has been shown to interact specifically with CD147 glycoprotein/chaperone to facilitate proper expression and function of MCT1 at the cell surface. SST significantly enhanced the membrane levels of CD147 as well as its association with MCT1. This association was completely abolished by the specific p38 MAP kinase inhibitor, SB203580. Our findings demonstrate that increased MCT1 association with CD147 at the apical membrane in response to SST is p38 MAP kinase dependent and underlies the stimulatory effects of SST on butyrate uptake.