Influence of improved antenatal detection on the outcomes of complete atrioventricular block diagnosed in fetal-neonatal life and childhood periods - a single-centre experience in South Wales for 55 years.

OBJECTIVE: This study aimed to analyse the influence of improved antenatal detection on the course, contemporary outcomes, and mortality risk factors of the complete atrioventricular block during fetal-neonatal and childhood periods in South Wales. METHODS: The clinical characteristics and outcomes of complete atrioventricular block in patients without structural heart disease at the University Hospital of Wales from January 1966 to April 2021 were studied. Patients were divided into two groups according to their age at diagnosis: I-fetal-neonatal and II-childhood. Contemporary outcomes during the post-2001 era were compared with historical data preceding fetal service development and hence earlier detection. RESULTS: There were 64 patients: 26 were identified in the fetal-neonatal period and the remaining 38 in the childhood period. Maternal antibodies/systemic lupus erythematosus disease (anti-Ro/Sjögren's-syndrome-related Antigen A and/or anti-La/Sjögren's-syndrome-related Antigen B) were present in 15 (57.7%) of the fetal-neonatal. Fetal/neonatal and early diagnosis increased after 2001 with an incidence of 1:25000 pregnancies. Pacemaker implantation was required in 34 patients, of whom 13 were diagnosed in the fetal-neonatal group. Survival rates in cases identified before 2001 were at 96.3% (26/27), whereas it was 83.8% (31/37) in patients diagnosed after 2001 (P > 0.05). Other mortality risk factors comprised a lower gestational week at birth, maternal antibodies, and an average ventricular heart rate of < 55 bpm. CONCLUSIONS: Fetal diagnosis of complete atrioventricular block is still portends high fetal and neonatal mortality and morbidity despite significantly improved antenatal detection after 2001. Pacemaker intervention is needed earlier in the fetal-neonatal group. Whether routine antenatal medical treatment might alter this outcome calls for further prospective multicentre studies.

Surface Phase Diagrams for Wetting with Long-Ranged Forces.

Recent density functional theory and simulation studies of wetting and drying transitions in systems with long-ranged, dispersionlike forces, away from the near vicinity of the bulk critical temperature T_{c}, have questioned the generality of the global surface phase diagrams for wetting, due to Nakanishi and Fisher, pertinent to systems with short-ranged forces. We extend these studies deriving fully analytic results which determine the surface phase diagrams over the whole temperature range up to T_{c}. The phase boundaries, order of, and asymmetry between the lines of wetting and drying transitions are determined exactly showing that they always converge to an ordinary surface critical point. We highlight the importance of lines of maximally multicritical wetting and drying transitions, for which we determine the exact critical singularities.

Abrupt onset of the capillary-wave spectrum at wall-fluid interfaces.

Surfaces between 3D solids and fluids exhibit a wide variety of phenomena both at equilibrium, such as roughening transitions, interfacial fluctuations and wetting, and also out-of-equilibrium, such as the surface growth of driven interfaces. These phenomena are described very successfully using lower dimensional (2D) effective models which focus on the physics associated with emergent mesoscopic lengths scales, parallel to the interface, where the 2D-like behaviour is physically transparent. However, the precise conditions under which this dimensional reduction is justifiable have remained unclear. Here we show that, for a wall-fluid interface, a dimensional reduction from 3D-like to 2D-like behaviour - identified via the decay of density correlations - occurs abruptly at a specific value of the contact angle, and indicates the beginning of interfacial-like 2D behaviour and the spontaneous onset of the capillary-wave spectrum. The reduction from 3D to 2D is characterised by the divergence of a correlation length perpendicular to the interface revealing a morphological change in the nature of density correlations. Counter-intuitive effects occur, including that 3D behaviour can persist up to the wetting temperature and also that 2D behaviour can begin when no wetting layer is present and the adsorption is negative.

Correction: Abrupt onset of the capillary-wave spectrum at wall-fluid interfaces.

Correction for 'Abrupt onset of the capillary-wave spectrum at wall-fluid interfaces' by Andrew O. Parry et al., Soft Matter, 2023, 19, 5668-5673, https://doi.org/10.1039/D3SM00761H.

Casimir Contribution to the Interfacial Hamiltonian for 3D Wetting.

Previous treatments of three-dimensional (3D) short-ranged wetting transitions have missed an entropic or low-temperature Casimir contribution to the binding potential describing the interaction between the unbinding interface and wall. This we determine by exactly deriving the interfacial model for 3D wetting from a more microscopic Landau-Ginzburg-Wilson Hamiltonian. The Casimir term changes the interpretation of fluctuation effects occurring at wetting transitions so that, for example, mean-field predictions are no longer obtained when interfacial fluctuations are ignored. While the Casimir contribution does not alter the surface phase diagram, it significantly increases the adsorption near a first-order wetting transition and changes completely the predicted critical singularities of tricritical wetting, including the nonuniversality occurring in 3D arising from interfacial fluctuations. Using the numerical renormalization group, we show that, for critical wetting, the asymptotic regime is extremely narrow with the growth of the parallel correlation length characterized by an effective exponent in quantitative agreement with Ising model simulations, resolving a long-standing controversy.

Initial results from an enhanced recovery program for pediatric cardiac surgical patients.

BACKGROUND: Over recent years, a number of enhanced recovery programs have appeared in first, adult colorectal surgery, and subsequently many other adult surgical specialties. Increasing interest in this approach to perioperative management in children culminated in the recent development of the first enhanced recovery pathway for pediatric intestinal surgery, endorsed by Enhanced Recovery after Surgery Society (ERAS®). In parallel, there has been increasing interest in the refinement of perioperative management of selected pediatric cardiac surgical patients, invariably referred to as "fast track" management. Initiatives have largely focused on duration of postoperative ventilation rather than on a much wider range of perioperative interventions to optimize recovery and ensure timely discharge after surgery. In our institution, a "Level 1" pediatric cardiac surgical center, we assembled a multidisciplinary team to design a comprehensive enhanced recovery pathway, based on ERAS® methodology, for selected cardiac surgical patients. After a lengthy period of planning, staff education, and preparation, we implemented the pathway at the end of November 2019. METHODS: We conducted a prospective audit of the perioperative management and outcomes of the first 88 patients managed according to this enhanced recovery pathway over a 25-month period in our institution. RESULTS: The mean age of the patients was 5.8 years (range 0.5-17.9), and the mean weight was 22.4 kg (range 6.6-57.2). Sixty-eight of the 88 patients were cardiopulmonary bypass cases. A total of 54% of patients received all four defined intraoperative anesthetic interventions (intravenous paracetamol, non-steroidal anti-inflammatory drug, antiemetic if aged more than 4 years, and use of a local anesthetic technique). A total of 89% of patients met the target extubation time of 6 h after administration of protamine. Median postoperative intensive care unit length of stay was 23.5 h (range 15.2-89.5). When compared to a historic control group, this represented a 22% reduction in median intensive care unit stay, although the total hospital length of stay remained unchanged. A total of 83% of patients met the target hospital discharge target of the fifth postoperative day. CONCLUSIONS: These preliminary results suggest that enhanced recovery pathway implementation for selected pediatric cardiac surgical patients is feasible, with acceptable outcomes. They suggest areas for further development and the potential for wider implementation.

MRI features of canine hemangiosarcoma affecting the central nervous system.

Hemangiosarcoma is the most common metastatic tumor involving the brain in dogs but detailed published descriptions of the magnetic resonance imaging (MRI) features are lacking. The objective of this multi-center, retrospective case series study was to describe MRI characteristics of canine hemangiosarcoma affecting the central nervous system (CNS). Medical records of seven referral institutions were retrospectively reviewed. Dogs were included if they had a histopathologically confirmed diagnosis of hemangiosarcoma affecting the CNS and undergone an MRI of the brain and/or vertebral column. Lesions were independently evaluated by two observers. Twenty dogs met the inclusion criteria and one dog had both intracranial and intramedullary hemangiosarcoma. Consistent MRI features included heterogeneous (17/21) lesions in all sequences with mainly mixed signal intensity (12/21), presence of susceptibility artifact on T2*w (15/16), associated moderate to severe perilesional edema (21/21), and moderate to strong (20/21) heterogeneous (14/21) or ring-like (6/21) contrast enhancement. Intracranial hemangiosarcoma was frequently multiple and intra-axial, affecting consistently the telencephalon and no differences in MRI features were found between primary and metastatic hemangiosarcoma. This is the first MRI description of primary intracranial hemangiosarcoma and primary intracranial epithelioid hemangiosarcoma. Vertebral hemangiosarcomas were segmental poorly marginated polyostotic and highly aggressive lesions invading the thoracic vertebral canal and paraspinal tissues. Epidural hemangiosarcomas were single and well-marginated lesions in the thoracolumbar and/or lumbar region. Intramedullary hemangiosarcomas were cervical, metastatic in origin, and frequently (3/4) accompanied by intracranial lesions. These described MRI features will aid early identification of hemangiosarcoma guiding subsequent diagnostics and therapeutics.

Edge Contact Angle, Capillary Condensation, and Meniscus Depinning.

We study the phase equilibria of a fluid confined in an open capillary slit formed when a wall of finite length H is brought a distance L away from a second macroscopic surface. This system shows rich phase equilibria arising from the competition between two different types of capillary condensation, corner filling and meniscus depinning transitions depending on the value of the aspect ratio a=L/H. For long capillaries, with a<2/π, the condensation is of type I involving menisci which are pinned at the top edges at the ends of the capillary characterized by an edge contact angle. For intermediate capillaries, with 2/π1, condensation is always of type II. In all regimes, capillary condensation is completely suppressed for sufficiently large contact angles. We show that there is an additional continuous phase transition in the condensed liquidlike phase, associated with the depinning of each meniscus as they round the upper open edges of the slit. Finite-size scaling predictions are developed for these transitions and phase boundaries which connect with the fluctuation theories of wetting and filling transitions. We test several of our predictions using a fully microscopic density functional theory which allows us to study the two types of capillary condensation and its suppression at the molecular level.

Breaking Cassie's Law for Condensation in a Nanopatterned Slit.

We study the phase transitions of a fluid confined in a capillary slit made from two adjacent walls, each of which are a periodic composite of stripes of two different materials. For wide slits the capillary condensation occurs at a pressure which is described accurately by a combination of the Kelvin equation and the Cassie law for an averaged contact angle. However, for narrow slits the condensation occurs in two steps involving an intermediate bridging phase, with the corresponding pressures described by two new Kelvin equations. These are characterised by different contact angles due to interfacial pinning, with one larger and one smaller than the Cassie angle. We determine the triple point and predict two types of dispersion force induced Derjaguin-like corrections due to mesoscopic volume reduction and the singular free-energy contribution from nanodroplets and bubbles. We test these predictions using a fully microscopic density functional model which confirms their validity even for molecularly narrow slits. Analogous mesoscopic corrections are also predicted for two-dimensional systems arising from thermally induced interfacial wandering.

Three-Phase Fluid Coexistence in Heterogenous Slits.

We study the competition between local (bridging) and global condensation of fluid in a chemically heterogeneous capillary slit made from two parallel adjacent walls each patterned with a single stripe. Using a mesoscopic modified Kelvin equation, which determines the shape of the menisci pinned at the stripe edges in the bridge phase, we determine the conditions under which the local bridging transition precedes capillary condensation as the pressure (or chemical potential) is increased. Provided the contact angle of the stripe is less than that of the outer wall we show that triple points, where evaporated, locally condensed, and globally condensed states all coexist are possible depending on the value of the aspect ratio a=L/H, where H is the stripe width and L the wall separation. In particular, for a capillary made from completely dry walls patterned with completely wet stripes the condition for the triple point occurs when the aspect ratio takes its maximum possible value 8/π. These predictions are tested using a fully microscopic classical density functional theory and shown to be remarkably accurate even for molecularly narrow slits. The qualitative differences with local and global condensation in heterogeneous cylindrical pores are also highlighted.

Susceptibility weighted imaging at 1.5 Tesla magnetic resonance imaging in dogs: Comparison with T2*-weighted gradient echo sequence and its clinical indications.

Susceptibility weighted imaging (SWI) is a high resolution, fully velocity-compensated, three-dimensional gradient echo (GE) MRI technique. In humans, SWI has been reported to be more sensitive than T2*-weighted GE sequences in the identification of both intracranial hemorrhage and intra-vascular deoxyhemoglobin. However, published clinical studies comparing SWI to T2*-weighted GE sequences in dogs are currently lacking. The aim of this retrospective, observational study was to compare SWI and T2*-weighted GE sequences in a group of dogs with intracranial disease. Medical records were searched for dogs that underwent a brain MRI examination that included T2*-weighted GE and SWI sequences. The presence and appearance of non-vascular and vascular signal voids observed on T2*-weighted GE and SWI were compared. Thirty-two dogs were included with the following diagnoses: presumed and confirmed intracranial neoplasia (27), cerebrovascular accidents (3), and trauma (2). Hemorrhagic lesions were significantly more conspicuous on SWI than T2*-weighted GE sequences (P < .0001). Venous structures were well defined in all SWI sequences, and poorly defined in all dogs on T2*-weighted GE. Susceptibility weighted imaging enabled identification of vascular abnormalities in 30 of 32 (93.8%) dogs, including: neovascularization in 19 of 32 (59.4%) dogs, displacement of perilesional veins in five of 32 (15.6%) dogs, and apparent dilation of perilesional veins in 10 of 32 (31.3%) dogs. Presence of neovascularization was significantly associated with T1-weighted post-contrast enhancement (P = .0184). Hemorrhagic lesions and venous structures were more conspicuous on SWI compared to T2*-weighted GE sequences. Authors recommend adding SWI to standard brain protocols in dogs for detecting hemorrhage and identifying venous abnormalities for lesion characterization.

Geometry-induced capillary emptying.

When a capillary is half-filled with liquid and turned to the horizontal, the liquid may flow out of the capillary or remain in it. For lack of a better criterion, the standard assumption is that the liquid will remain in a capillary of narrow cross-section, and will flow out otherwise. Here, we present a precise mathematical criterion that determines which of the two outcomes occurs for capillaries of arbitrary cross-sectional shape, and show that the standard assumption fails for certain simple geometries, leading to very rich and counterintuitive behavior. This opens the possibility of creating very sensitive microfluidic devices that respond readily to small physical changes, for instance, by triggering the sudden displacement of fluid along a capillary without the need of any external pumping.

Modified Kelvin Equations for Capillary Condensation in Narrow and Wide Grooves.

We consider the location and order of capillary condensation transitions occurring in deep grooves of width L and depth D. For walls that are completely wet by liquid (contact angle θ=0) the transition is continuous and its location is not sensitive to the depth of the groove. However, for walls that are partially wet by liquid, where the transition is first order, we show that the pressure at which it occurs is determined by a modified Kelvin equation characterized by an edge contact angle θ_{E} describing the shape of the meniscus formed at the top of the groove. The dependence of θ_{E} on the groove depth D relies, in turn, on whether corner menisci are formed at the bottom of the groove in the low density gaslike phase. While for macroscopically wide grooves these are always present when θ<45° we argue that their formation is inhibited in narrow grooves. This has a number of implications including that the local pinning of the meniscus and location of the condensation transition is different depending on whether the contact angle is greater or less than a universal value θ^{*}≈31°. Our arguments are supported by detailed microscopic density functional theory calculations that show that the modified Kelvin equation remains highly accurate even when L and D are of the order of tens of molecular diameters.

Knowledge and skills of critical care nurses in assisting with intubation.

Assisting with tracheal intubation is an aspect of clinical practice that requires knowledge and skill if the procedure is to be carried out in a timely and safe manner. Maintaining this knowledge and skill requires good quality education and regular opportunities to practise. These two factors appear to be inconsistent in critical care units. This article details an audit performed on a large tertiary referral centre critical care unit. It was undertaken in two phases: the first was a self-assessment of knowledge and the second was a practical assessment of the audit subjects in a simulated setting. Results indicated that formal training was inconsistent, as was the opportunity to assist with tracheal intubation. These factors may have contributed to the varying levels of skill seen in the practical assessment phase. The authors recommend devising a standardised training programme to address these issues, which could be distributed nationally. High standards need to be instilled early in critical care nurses' careers, with regular updates to maintain knowledge and skills.

Longer-term outcome of perventricular device closure of muscular ventricular septal defects in children.

OBJECTIVE: To describe the longer-term clinical experience and follow-up with perventricular device closure of ventricular septal defects (VSD) in children. METHODS: Between January 2005 and December 2013, muscular ventricular septal defect closure with the Amplatzer Muscular VSD Occluder was undertaken using a hybrid perventricular approach. Data including demographic, echocardiographic parameter, and clinical outcome were reviewed retrospectively. RESULTS: Median age at the time of procedure was 8.9 months (range 1.9-31.0 months) and median weight was 6.6 kg (range 4.5-12.9 kg). All had a moderate to large muscular VSD, three had more than one VSD, four had previous coarctation repair, and five had previous pulmonary artery (PA) banding. A single Amplatzer muscular occluder (range 8-18 mm) was deployed in each patient without cardiopulmonary bypass under echocardiographic guidance. Two of ten patients subsequently required a short period of cardiopulmonary bypass for reconstruction of PA after de-banding and closure of atrial septal defect in one. Occluder removal was necessary in one patient due to entrapment of the tricuspid valve and progressive tricuspid regurgitation. This patient underwent surgical repair with a good result and no device-related valve damage. In the remaining nine patients, no severe complications such as device embolization, arrhythmia, or significant valve regurgitation were noted in the post-operative period or follow-up. At a median time of 6.5 years (range 0.9-8.4 years) post device implantation, complete closure was achieved in five patients and four had small residual leaks, which were not hemodynamically significant. CONCLUSION: Perventricular muscular VSD closure is effective in small children with suitable muscular defects and may avoid the morbidity associated with cardiopulmonary bypass and conventional surgical repair. There have been no late complications with this approach.

Differentiation between inflammatory and neoplastic orbital conditions based on computed tomographic signs.

OBJECTIVE: To identify computed tomographic (CT) signs that could be used to differentiate inflammatory from neoplastic orbital conditions in small animals. ANIMAL STUDIED: Fifty-two animals (25 cats, 21 dogs, 4 rabbits, and 2 rodents). PROCEDURE: Case-control study in which CT images of animals with histopathologic diagnosis of inflammatory (n = 11), neoplastic orbital conditions (n = 31), or normal control animals (n = 10) were reviewed independently by five observers without the knowledge of the history or diagnosis. Observers recorded their observations regarding specific anatomical structures within the orbit using an itemized form containing the following characteristics: definitely normal; probably normal; equivocal; probably abnormal; and definitely abnormal. Results were statistically analyzed using Fleiss' kappa and logistic regression analyses. RESULTS: The overall level of agreement between observers about the presence or absence of abnormal CT signs in animals with orbital disease was poor to moderate, but was highest for observations concerning orbital bones (κ = 0.62) and involvement of the posterior segment (κ = 0.52). Significant associations between abnormalities and diagnosis were found for four structures: Abnormalities affecting orbital bones (odds ratio [OR], 1.7) and anterior ocular structures (OR, 1.5) were predictive of neoplasia, while abnormalities affecting extraconal fat (OR, 1.7) and skin (OR, 1.4) were predictive of inflammatory conditions. CONCLUSIONS: Orbital CT is an imaging test with high specificity. Fat stranding, a CT sign not previously emphasized in veterinary medicine, was significantly associated with inflammatory conditions. Low observer agreement probably reflects the limited resolution of CT for small orbital structures.

Towards a safety net for management of 22q11.2 deletion syndrome: guidelines for our times.

UNLABELLED: The commonest autosomal deletion, 22q11.2 deletion syndrome (22q11DS) is a multisystem disorder varying greatly in severity and age of identification between affected individuals. Holistic care is best served by a multidisciplinary team, with an anticipatory approach. Priorities tend to change with age, from feeding difficulties, infections and surgery of congenital abnormalities particularly of the heart and velopharynx in infancy and early childhood to longer-term communication, learning, behavioural and mental health difficulties best served by evaluation at intervals to consider and initiate management. Regular monitoring of growth, endocrine status, haematological and immune function to enable early intervention helps in maintaining health. CONCLUSION: Guidelines to best practice management of 22q11DS based on a literature review and consensus have been developed by a national group of professionals with consideration of the limitations of available medical and educational resources.

Pulmonary valve cyst mimicking pulmonary artery neoplasia: a case report.

Cardiac valve cysts are rare beyond infancy. The tricuspid and mitral valve are the most common sites, with few reported cases of pulmonary valve cysts in the literature. This case illustrates a pulmonary valve cyst mimicking a tumour in a child 13 years after cardiac surgery. Although these lesions are extremely rare, they could be considered in the differential diagnosis in patients presenting with valvular mass lesions.

Critical-point wedge filling and critical-point wetting.

For simple fluids adsorbed at a planar solid substrate (modeled as an inert wall) it is known that critical-point wetting, that is, the vanishing of the contact angle θ at a temperature T_{w} lying below that of the critical point T_{c}, need not occur. While critical-point wetting necessarily happens when the wall-fluid and fluid-fluid forces have the same range (e.g., both are long ranged or both short ranged) nonwetting gaps appear in the surface phase diagram when there is an imbalance between the ranges of these forces. Here we show that despite this, the convergence of the lines of constant contact angle, 0<θ<π, to an ordinary surface phase transition at T_{c}, means that fluids adsorbed in wedges (and cones) always exhibit critical-point filling (wedge wetting or wedge drying) regardless of the range and imbalance of the forces. We illustrate the necessity of critical-point filling, even in the absence of critical-point wetting, using a microscopic model density functional theory of fluid adsorption in a right angle wedge, with dispersion and also retarded dispersionlike wall-fluid forces. The location and order of the filling phase boundaries are determined and shown to be in excellent agreement with exact thermodynamic requirements and also predictions for critical singularities based on interfacial models.