Background. The Ross procedure has been increasingly applied to neonates and infants. Addition of a modified Konno-type enlargement of the aortic annulus allows the application of this procedure to ...neonates and infants with significant annular hypoplasia. The potential for growth and the proven durability make the autograft an ideal aortic valve replacement.
Methods. Between March 1993 and December 2000, 10 patients under 1 year of age underwent a Ross/Konno procedure at our institution (range, 2 to 349 days; median 16). All patients had severe to critical aortic stenosis. All patients required aortic annulus enlargement for size mismatch between the aortic and pulmonary valves.
Results. There were no deaths at a median follow-up of 48 months (range, 1 to 74 months). All patients had none to mild aortic stenosis on Doppler echocardiography. Eight patients had a 0 to 1+ aortic insufficiency, 1 patient had a 2+ aortic insufficiency, and 1 patient had a 3+ aortic insufficiency. Aortic annular dilatation was not observed. Aortic sinus dilatation occurred initially (mean change in z-value: 0 to 12 months, +2.1) and then stabilized (mean change in z-value: 12 to > 36 months, +0.6). No patient required additional procedures for aortic valve disease. Two patients required three pulmonary allograft replacements.
Conclusions. The Ross procedure with a modified Konno-type enlargement of the aortic annulus is an excellent approach to aortic valve disease in the neonate and infant. The procedure can be accomplished with low morbidity and mortality, and low rates of reoperation. The pulmonary autograft demonstrates durability without developing aortic stenosis, aortic insufficiency, or progressive dilatation. Enlargement of the aortic annulus parallels somatic growth.
Animal feeds may be contaminated, accidentally or maliciously, with a number of zoonotic bacteria. Animal infections with these bacterial agents, whether or not they cause animal disease, may lead to ...human illnesses. Anhydrous ammonia was introduced on farms in developed countries as a high-nitrogen soil amendment, but later found use in enhancing crude protein in low-quality roughage fed to ruminants and in neutralizing mycotoxins in fungus-infested feed grains. Although ammonia has been known to be effective against bacteria in other contexts (e.g., manure, community sewage sludge, seeds for sprouting, and boneless lean beef trimmings), it appears that the antibacterial effect of ammoniating animal feeds had not been tested. In the present study, samples of roughage (wheat straw, corn silage) and concentrates (corn grain, cottonseed) produced as animal feed were contaminated with dried-on zoonotic bacteria (
Salmonella Newport in all;
Campylobacte jejuni,
E. coli O157:H7,
Listeria monocytogenes,
Yersinia enterocolitica in corn grain only). Disinfection with anhydrous ammonia gas was conducted for 24 h at room temperature (∼
25 °C). The treatment was least effective in silage because the silage alone showed strong antibacterial activity, which may have been slightly reduced by ammoniation. In the other three feeds, depending on the initial level of contamination, ammonia destruction of ≥
5 log
10 cfu/g (99.999%) of the selected contaminant was usually observed.
Iron needles in supernova remnants? Gomez (née Morgan), Haley L.; Dunne, Loretta; Eales, Stephen A. ...
Monthly notices of the Royal Astronomical Society,
08/2005, Letnik:
361, Številka:
3
Journal Article
Recenzirano
Odprti dostop
It has been suggested by Dwek that iron needles could explain the submillimetre emission from the Cas A supernova remnant (SNR) with only a very small total mass. We investigate whether a similar ...model holds for the Kepler SNR, and find that its emission could indeed be explained by a dust mass of less than 10–2 M⊙, dependent on the axial ratio l /a of the needles—which we constrain to be less than 700. But the implied needle model for Kepler is inconsistent with that suggested for Cas A since either the needles would have to have a resistivity one or two orders of magnitude greater than those in Cas A or the electron density in Kepler's shocked plasma must be 40 times greater than suggested by X-ray observations. An additional problem with the needle model is that the implied thickness of the needles seems to be implausibly small, if the emission properties are calculated under the usual approximations.
Linguiça, a smoked sausage originally from Portugal, is often made in small quantities in California, without inspection. Campylobacter jejuni, Escherichia coli O157:H7, Listeria monocytogenes, ...Salmonella enterica serotype Newport, and Yersinia enterocolitica were added individually to batter representing California linguiça. Batter (≤1 mm thick), heated at 50, 55, and 60 °C, showed decimal reduction times ranging from >10 min for most trials at 50 °C to <2 min at 60 °C. Pork casings, stuffed with the batters to a diameter ≤3 cm, length 10 cm, and weight 75–80 g, were hot smoked; sausage centers were at ≥60 °C for ≥90 min. Contaminant levels in the batters (three experiments/pathogen) ranged from 2.3 × 106 to 3.0 × 1010 CFU/g in various runs; reductions were ≥5 log10 in all cases. These experiments indicate a reasonable margin of safety for products processed in this way.
Left ventricular outflow tract obstruction remains an early and late complication after repair of interrupted aortic arch and ventricular septal defect. We reviewed our experience with the selective ...management of the infundibular septum during primary repair to address left ventricular outflow tract obstruction.
From 1991 through 2001, all 27 patients presenting with interrupted aortic arch/ventricular septal defect and posterior deviation of the infundibular septum were analyzed. Fifteen patients with the smallest subaortic areas underwent myectomy or myotomy of the infundibular septum concomitant with interrupted aortic arch/ventricular septal defect repair.
Patients undergoing myectomy-myotomy (Group I) had significantly smaller subaortic diameter indexes (0.83 ± 0.16 cm/m
2) when compared with those who had only interrupted aortic arch/ventricular septal defect repair (group 2: 0.99 ± 0.13 cm/m
2,
P = .012). Two hospital deaths occurred in group 1, and 1 occurred in group 2. No late deaths occurred. No patient in group 2 required reoperation. Six group 1 patients required 9 reoperations for left ventricular outflow tract obstruction. Five patients underwent resection of a new subaortic membrane. Only 1 patient had recurrent muscular left ventricular outflow tract obstruction. Three patients required a second reoperation, primarily related to aortic valve stenosis.
Interrupted aortic arch/ventricular septal defect with posterior malalignment of the infundibular septum can be repaired with low mortality in the neonatal period. Tailored to the degree of subaortic narrowing, resection or incision of the infundibular septum at the time of primary repair was very effective in preventing or prolonging the interval to recurrent left ventricular outflow tract obstruction compared with the published data. However, reoperation for left ventricular outflow tract obstruction, often related to the development of a new and discrete subaortic membrane or valvar stenosis, is still required in a subset of patients.
There has traditionally been less concern regarding coronary anomalies with left‐sided congenital heart lesions such as hypoplastic left heart syndrome (HLHS)
or Shone complex than with other ...lesions. However, coronary anomalies in this setting can profoundly affect surgical intervention, particularly when surgical repair involves the ascending aorta. We describe four patients with congenital left‐sided heart lesions in which left coronary artery (LCA) anomalies substantially affected intervention and outcome. In the first two cases, the coronary anomalies were not identified prospectively and resulted in surgical injury directly to the coronary or to its surrounding region. In the latter two cases, successful identification of the coronary anomaly preoperatively allowed for modification of surgical technique and/or intervention. We conclude that detailed coronary artery assessment should be part of the routine echocardiographic evaluation of congenital left‐sided heart lesions that require surgery.
The Socorro Warbler (Setophaga pitiayumi graysoni) is currently classified as a subspecies of the Tropical Parula. This bird is endemic to Socorro Island, and due to the island’s distance from ...mainland Mexico and likely low levels of gene flow for this non-migratory species, we expected this form to exhibit significant divergence from its mainland counterparts. Here, we analyzed the phylogenetic position of the Socorro Warbler and examined its taxonomic status. Using blood samples from four individual Socorro Warblers, we performed phylogenetic analyses using the nuclear genes rhodopsin intron 1 (RDPSN) and transforming growth factor beta-2 (TGFB2), and the mitochondrial genes ATPase and cytochrome b. Bayesian inference, maximum-likelihood, and maximum parsimony analyses were employed to determine the genetic relationship of the Socorro Warbler to its mainland counterparts. Results reveal significant genetic divergence and a basal position of the Socorro Warbler relative to its mainland counterparts. Based on its distinct phylogenetic placement and geographical isolation, we recommend returning the Socorro Warbler to its original specific status, Setophaga graysoni, based on its taxonomic history. This case illustrates the importance of preserving island habitats to save unique island biodiversity that otherwise could pass unnoticed.
Seeing the stolen starlight with Herschel Gomez, Haley L.; Gomez, Edward L.; Hargrave, Peter
Proceedings of the International Astronomical Union,
01/2009, Letnik:
5, Številka:
S260
Journal Article
Recenzirano
Odprti dostop
The Herschel Space Observatory is ESA's fourth Cornerstone mission and will be the largest, most sensitive telescope ever put into space. It will be the first space observatory to observe from the ...far-infrared to the submillimetre waveband, unveiling the cool, hidden universe for the first time. Herschel will observe stars and galaxies at the stage of formation and discover where all the cosmic dust polluting galaxies comes from. Given the huge public interest in large space missions such as Hubble and Spitzer, Herschel is an ideal opportunity to excite and inform the UK public during the International Year of Astronomy 2009. Here we present some of the education and outreach projects created by the Herschel Outreach Group (HOG).
We discuss the creation of the World's largest homogeneous telescope network. We summarize both the scientific and education programmes, and outline why this organization provides unique ...opportunities for anyone interested in astronomy, whether they are professionals or amateurs, experienced or novice.
This review encompasses the most important advances in liver functions and hepatotoxicity and analyzes which mechanisms can be studied in vitro. In a complex architecture of nested, zonated lobules, ...the liver consists of approximately 80 % hepatocytes and 20 % non-parenchymal cells, the latter being involved in a secondary phase that may dramatically aggravate the initial damage. Hepatotoxicity, as well as hepatic metabolism, is controlled by a set of nuclear receptors (including PXR, CAR, HNF-4α, FXR, LXR, SHP, VDR and PPAR) and signaling pathways. When isolating liver cells, some pathways are activated, e.g., the RAS/MEK/ERK pathway, whereas others are silenced (e.g. HNF-4α), resulting in up- and downregulation of hundreds of genes. An understanding of these changes is crucial for a correct interpretation of in vitro data. The possibilities and limitations of the most useful liver in vitro systems are summarized, including three-dimensional culture techniques, co-cultures with non-parenchymal cells, hepatospheres, precision cut liver slices and the isolated perfused liver. Also discussed is how closely hepatoma, stem cell and iPS cell–derived hepatocyte-like-cells resemble real hepatocytes. Finally, a summary is given of the state of the art of liver in vitro and mathematical modeling systems that are currently used in the pharmaceutical industry with an emphasis on drug metabolism, prediction of clearance, drug interaction, transporter studies and hepatotoxicity. One key message is that despite our enthusiasm for in vitro systems, we must never lose sight of the in vivo situation. Although hepatocytes have been isolated for decades, the hunt for relevant alternative systems has only just begun.
PDF
