Prematurity and congenital heart disease (CHD) are the leading causes of neonatal mortality and morbidity. Limited data are available about the outcomes of premature infants with severe CHD.
We ...queried The National Inpatient Database using ICD-10 codes for premature patients (<37 weeks) with severe CHD from 2016 to 2020. Severe CHDs were grouped into three categories: A. left-sided lesions with impaired systemic output, B. Cyanotic CHD, and C. Shunt lesions with pulmonary overcirculation. Patients with isolated atrial or ventricular septal defects and patent ductus arteriosus were excluded. We also excluded patients with chromosomal abnormalities and major congenital anomalies. Patients' demographics, clinical characteristics, and outcomes were evaluated by comparing premature infants with vs. without CHD adjusting for gestational age (GA), birth weight, and gender.
A total of 27710 (1.5%) out of 1,798,245 premature infants had severe CHD. This included 27%, 58%, and 15% in groups A, B, and C respectively. The incidence of severe CHD was highest between 25 and 28 weeks of gestation and decreased significantly with increasing GA up to 36 weeks (
< 0.001). Premature infants with severe CHD had a significantly higher incidence of neonatal morbidities including necrotizing enterocolitis (NEC) OR = 4.88 (4.51-5.27), interventricular hemorrhage OR = 6.22 (5.57-6.95), periventricular leukomalacia OR = 3.21 (2.84-3.64) and bronchopulmonary dysplasia OR = 8.26 (7.50-10.06) compared to preterm infants of similar GA without CHD. Shunt lesions had the highest incidence of NEC (8.5%) compared to 5.3% in cyanotic CHD and 3.7% in left-sided lesions (
< 0.001). Mortality was significantly higher in premature infants with CHD compared to control 11.6% vs. 2.5%,
< 0.001. Shunt lesions had significantly higher mortality (11.0%) compared to those with left-sided lesions (8.3%) and cyanotic CHD (6.4%),
< 0.001.
Premature infants with severe CHD are at high risk of neonatal morbidity and mortality. Morbidity remains increased across all GA groups and in all CHD categories. This significant risk of adverse outcomes is important to acknowledge when managing this patient population and when counseling their families. Future research is needed to examine the impact of specific rather than categorized congenital heart defects on neonatal outcomes.
We investigated the role of postnatal steroids on the severity of retinopathy of prematurity (ROP) and its impact on peripheral avascular retina (PAR).
A retrospective cohort study of infants born at ...≤32 weeks gestation and/or birth weight ≤1500 g. Demographics, the dose and duration of steroid treatment, and age when full retinal vascularization occurred were collected. The primary outcomes were the severity of ROP and time to full vascularization of the retina.
A total of 1695 patients were enrolled, 67% of whom received steroid therapy. Their birth weight was 1142 ± 396 g and gestational age was 28.6 ± 2.7 weeks. The total hydrocortisone-equivalent dose prescribed was 28.5 ± 74.3 mg/kg. The total days of steroid treatment were 8.9 ± 35.1 days. After correction for major demographic differences, infants who received a higher cumulative dose of steroids for a longer duration had a significantly increased incidence of severe ROP and PAR (P < 0.001). For each day of steroid treatment, there was a 3.2% increase in the hazard of the severe form of ROP (95% CI: 1.022-1.043) along with 5.7% delay in achieving full retinal vascularization (95% CI: 1.04-1.08) (P < 0.001).
Cumulative dose and duration of postnatal steroid use were independently associated with the severity of ROP and PAR. Thus, postnatal steroids should be used very prudently.
We report ROP outcomes in a large cohort of infants from two major healthcare systems where we have studied the impact of postnatal steroids on the severity of ROP, growth, and development of retinal vessels. After correcting our data for three major outcome measures, we show that high-dose postnatal steroids used for a prolonged duration of time are independently associated with severe ROP and delay in retinal vascularization. Postnatal steroids impact the visual outcomes of VLBW infants significantly, so their clinical use needs to be moderated.
Abstract
ORCA, Oscillation Research with Cosmics in the Abyss, is the low energy KM3NeT neutrino underwater detector, located in the French Mediterranean Sea. It comprises a dense array of optical ...modules designed to detect Cherenkov light emitted from charged particles resulting from neutrino interactions in the vicinity of the detector. Its main physics goal is the determination of the neutrino mass hierarchy by quantifying the matter-induced effect on the oscillation probabilities of atmospheric neutrinos in the energy range, 3–50 GeV, where the effects of neutrino oscillation phenomena are dominant. In 2019, four detection units were operational. Two more had been added in early 2020. This work presents an overview of the detector performance in the 2019 configuration, as well as its sensitivity to neutrino oscillations.
The use of silver zeolite for the capture of radioiodine from the vapour phase, followed by thermal conversion now appears to be the most direct route by which a sodalite wasteform can be formed. In ...addition, consolidation by hot-isostatic pressing (HIP) in sealed canisters has many significant advantages over conventional methods such as sintering or melting these candidate wasteforms. The choice of HIP canister material is important as reaction at the wasteform/HIP canister interface results in an interaction zone that can potentially produce detrimental phases, wasteform porosity and canister thinning. This paper builds on a previous study that demonstrated that iodine could be captured from the vapour phase using silver exchanged zeolite and converted to sodalite by HIPing in Fe HIP canisters. The Cu or Ni metal HIP canisters used in this work result in an ∼100–200 μm thick local interaction zone with a variety of chemistries. Durability studies were conducted using a variety of reducing conditions and clearly demonstrated the redox sensitivity of silver sodalite. While the silver sodalite wasteform produced is, like the popular AgI-based wasteforms, highly leach resistant to leaching by deionised water it was unstable under highly reducing conditions, which are likely to occur in most geological disposal facilities. Post leaching characterisation revealed the redeposition of AgI and the formation of an aluminosilicate alteration layer under some leaching conditions. Appropriate precautions are required should a silver sodalite wasteform for iodine immobilisation be exposed to reducing groundwater conditions.
•Iodine loaded silver exchanged zeolite converts to silver sodalite-rich wasteform after HIPping in Cu or Ni canisters.•Interfacial reaction zones ∼100–200 µm form between the wasteform and both Cu and Ni HIP canisters.•Durability testing indicates that the wasteform is highly resistant to leaching in deionised water.•Silver sodalite is destabilised under reducing groundwater conditions that may occur in geological disposal facilities.
Background
DNA barcoding have been considered as a tool to facilitate species identification based on its simplicity and high-level accuracy in compression to the complexity and subjective biases ...linked to morphological identification of taxa. MaturaseK gene (
MatK gene)
of the chloroplast is very vital in the plant system which is involved in the group II intron splicing. The main objective of this study is to determine the relative utility of the “
MatK
” chloroplast gene for barcoding in 15 legume as a tool to facilitate species identification based on their simplicity and high-level accuracy linked to morphological identification of taxa.
Methods and Results
MatK
gene sequences were submitted to GenBank and the accession numbers were obtained with sequence length ranging from 730 to 1545 nucleotides. These DNA sequences were aligned with database sequence using PROMALS server
,
Clustal Omega server and Bioedit program. Maximum likelihood and neighbor-joining algorithms were employed for constructing phylogeny. Overall, these results indicated that the phylogenetic tree analysis and the evolutionary distances of an individual dataset of each species were agreed with a phylogenetic tree of all each other consisting of two clades, the first clade comprising
(Enterolobium contortisiliquum, Albizia lebbek), Acacia saligna
,
Leucaena leucocephala, Dichrostachys Cinerea, (Delonix regia, Parkinsonia aculeata), (Senna surattensis, Cassia fistula, Cassia javanica)
and
Schotia brachypetala
were more closely to each other, respectively. The remaining four species of
Erythrina humeana, (Sophora secundiflora, Dalbergia Sissoo, Tipuana Tipu)
constituted the second clade.
Conclusion
Moreover, their sequences could be successfully utilized in single nucleotide polymorphism or as part of the sequence as DNA fragment analysis utilizing polymerase chain reaction in plant systematic. Therefore,
MatK
gene is considered promising a candidate for DNA barcoding in the plant family Fabaceae and provides a clear relationship between the families.
Aims : Fibrofatty replacement of the right ventricle wall, often with associated inflammation, is the hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare but established cause ...of sudden cardiac death in young adults. Fatty infiltration of the right ventricle alone without fibrosis may also occur but its relation to sudden death is not well established. In this study we assessed the amount of epicardial and intramyocardial fat in the right ventricle of ‘normal’ hearts from subjects who had died of non‐cardiac causes.
Methods and results : Hearts (n = 148) were examined from 81 males and 67 females, with an age range of 6 months to 68 years, who had died of non‐cardiac causes. The extent and distribution of right ventricular epicardial and intramyocardial fat was assessed macro‐ and microscopically, respectively. The majority of hearts (85%) contained at least some intramyocardial fat with significantly more fat replacement noted in the right ventricles of older subjects and in females than in males. There was no significant fibrosis or inflammation in any of the 148 cases.
Conclusion : Variable amounts of intramyocardial fat may be seen in the right ventricle of subjects dying of non‐cardiac related causes. Care should be taken not to confuse this relatively common simple fatty infiltration with ARVC.
Adsorption of U(VI) and other heavy metals on millimetre sized polymer-coated polyacrylinitrile (PAN) beads was investigated. PAN was used as scaffolds for the polymer layer thus producing porous ...material of high surface area, improved mechanical strength and improved adsorption capabilities. Extensive U(VI) adsorption studies were undertaken and results modelled using different kinetic and equilibrium models. Parameters including thermodynamic parameters were evaluated. Sorbent capacities were assessed as 124, 16, and 33 mg g
−1
for PCP, SPP and Dowex at 60 °C respectively. U(VI) adsorption mechanism for these adsorbents was postulated. Recovered uranium may be used for production of cheap electricity.
Vitamin D has been used in the context of secondary hyperparathyroidism in patients with end-stage renal disease. A wave of recent studies suggests that vitamin D treatment may be associated with ...decreased mortality risk in these patients. The article by Wolf et al. further supports these studies by identifying vitamin D deficiency as a risk factor for early mortality in incident hemodialysis patients.
► In dilute solutions, Na, Al and Si releases were not sensitive to pH in range 4–10. ► On heating from 18 to 90°C in DIW, Na dissolution rate increased by a factor of ∼4. ► Elemental extractions in ...DIW at 18°C increased linearly with time over 1–7days. ► Na release kinetics in DIW followed a pseudo-second-order kinetic model. ► Contact with KCl, KHCO3 and phthalate buffers (pH6 & 10) resulted in Na+↔K+ exchange.
In dilute aqueous solutions, the elemental releases of Na, Al and Si from a metakaolin-based sodium aluminosilicate geopolymer were not very sensitive to pH in the range of 4–10 but increased outside this range, particularly on the acidic side. To minimise pH drifts, experiments were carried out using small amounts of graded powders in relatively large volumes of water. In deionised water, the Na dissolution rate in 7days was dominant and increased by at least a factor of ∼4 on heating from 18 to 90°C, with greater increases in the extractions of Al and Si. At 18°C the elemental extractions in deionised water increased approximately linearly with time over the 1–7days period. Further exposure led to a slower extraction into solution for Na and Si, with a decrease in extraction of Al. It was deduced that framework dissolution was important in significantly acidic or alkaline solutions, but that contributions from water transfer from pores to elemental extractions were present, even at low temperatures in neutral solutions. It was also deduced from the Na release data that the Na leaching kinetics of geopolymer in deionised water (dilute solutions) followed the pseudo-second-order kinetic model and the pseudo-second-order rate constant evaluated. Contact with KCl, KHCO3, and pH ∼6 and 10 potassium phthalate buffer solutions gave rise to a high degree of Na+↔K+ exchange and rendered the framework ions less leachable in water.
Controversial data exist about the impact of Down syndrome on outcomes after surgical repair of atrioventricular septal defect.
(A) assess trends and outcomes of atrioventricular septal defect with ...and without Down syndrome and (B) determine risk factors associated with adverse outcomes after atrioventricular septal defect repair.
We queried The National Inpatient Sample using International Classification of Disease codes for patients with atrioventricular septal defect < 1 year of age from 2000 to 2018. Patients' characteristics, co-morbidities, mortality, and healthcare utilisation were evaluated by comparing those with versus without Down syndrome.
In total, 2,318,706 patients with CHD were examined; of them, 61,101 (2.6%) had atrioventricular septal defect. The incidence of hospitalisation in infants with atrioventricular septal defect ranged from 4.5 to 7.5% of all infants hospitalised with CHD per year. A total of 33,453 (54.7%) patients were associated with Down syndrome. Double outlet right ventricle, coarctation of the aorta, and tetralogy of Fallot were the most commonly associated with CHD in 6.9, 5.7, and 4.3% of patients, respectively. Overall atrioventricular septal defect mortality was 6.3%. Multivariate analysis revealed that prematurity, low birth weight, pulmonary hypertension, and heart block were associated with mortality. Down syndrome was associated with a higher incidence of pulmonary hypertension (4.3 versus 2.8%, p < 0.001), less arrhythmia (6.6 versus 11.2%, p < 0.001), shorter duration for mechanical ventilation, shorter hospital stay, and less perioperative mortality (2.4 versus 11.1%, p < 0.001).
Trends in atrioventricular septal defect hospitalisation had been stable over time. Perioperative mortality in atrioventricular septal defect was associated with prematurity, low birth weight, pulmonary hypertension, heart block, acute kidney injury, and septicaemia. Down syndrome was present in more than half of atrioventricular septal defect patients and was associated with a higher incidence of pulmonary hypertension but less arrhythmia, lower mortality, shorter hospital stay, and less resource utilisation.
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