The medieval outlaw appears in historical, religious, and legal texts of late Medieval England and is imagined in fiction as well, specifically in the romance narratives of Geoffrey Chaucer. Outlawry ...was a legal state that could be imposed. Chaucer found himself occasionally outside the law at different points of his life, an item to consider when examining Chaucer’s representation of knights acting outside the chivalric code. He populates his romances with outlawry, illustrating the ethical, legal, and social assumptions of their own times. In Chaucer, knights can sometimes be outlaws, and when they are, they are often portrayed as running amok or going mad, leading them to a quest or to an act that must be completed before they can be reintroduced into society. Early critics Maurice Keen and Eric Hobsbawm narrowly defined what they saw as outlawry in medieval literature, but the more recent work of Timothy S. Jones renews the possibility of better examining outlawry’s intersection with medieval romance. Outlawry has traditionally been associated with the narratives of Robin Hood. Yet broadening the definitions of what constitutes an outlaw narrative can lead to fresh readings of Chaucer’s work. To be outlawed, in medieval fiction, carries with it an additional displacement of a character’s connection to others. In this project, I examine fictional knights tarrying in outlawed space while grounding my argument in historical narratives. In doing so, I illuminate how outlawry intersects with medieval romance, unveiling chivalry’s ideological blemishes.
Fontan pathway obstruction is a potentially serious complication characterized by an anatomical or functional narrowing anywhere in the cavo-pulmonary pathways. Here, we report the first case in the ...literature where an innovative Fontan conduit rehabilitation procedure with intravascular lithotripsy was used achieving a dramatic increase in the pathway size.
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Improvements in the synthesis, deprotection and purification of oligoribonucleotides are described. These advances allow for reduced synthesis and deprotection times, while improving product yield. ...Coupling times are reduced by half using 5-ethyrthic-1 H-tetrazole (S-ethyltetrazole) as the activator. Base and 2′-O-t-butyldimethylsllyl deprotection with methylamlne (MA) and anhydrous trtethylamlne/hydrogen fluoride In W-methylpyrrolidinone (TEAHF/NMP), respectively, requires a fraction of the time necessitated by current standard methods. In addition, the ease of ollgoribonucleotlde purification and analysis have been significantly enhanced using anion exchange chromatography. These new methods Improve the yield and quality of the oligoribonucleotides synthesized. Hammerhead ribozymes synthesized utilizing the described methods exhibited no diminution in catalytic activity.
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Introduction:
Fontan pathway obstruction is a serious complication characterized by an anatomical or functional narrowing anywhere in the cavo-pulmonary pathways. Here we report the ...first case where an innovative Fontan conduit rehabilitation procedure with intravascular lithotripsy was used achieving a significant increase in the pathway size.
Case:
A 28-year-old male with tricuspid atresia status-post Fontan palliation (age 23 months) with bare metal stent implant to treat obstruction at age 15, presented with syncope, ascites and varicose veins. Imaging studies revealed a cirrhotic liver morphology and Fontan pathway obstruction with minimal diameter of 12 mm. Cardiac catheterization confirmed severe Fontan conduit obstruction in addition to LPA stenosis. Serial covered Cheatham-Platinum stents were implanted for conduit coverage followed by Palmaz stents. Non-compliant Atlas balloon dilation to 20 atm was performed without expansion of the Fontan pathway beyond 12 mm due to severe calcification. A 7.0 x 60 mm shock-wave lithotripsy balloon was added alongside the Atlas balloon to modulate the heavily calcified wall with subsequent expansion of the conduit to 21 mm after inflating the Atlas balloon to 14 atm.
Discussion:
Several studies demonstrated that transcatheter stenting of stenotic Fontan conduits can be safely performed. Intravascular lithotripsy has emerged as a novel therapy for the treatment of coronary vascular calcification. We report the first case of an innovative percutaneous Fontan conduit rehabilitation procedure using a lithotripsy shock wave balloon in an adult with severely calcified Fontan pathway obstruction and prior stents, achieving a 75% increase in the pathway size without significant complications. Further studies are needed to evaluate the long-term safety and efficacy of this novel approach, but this case presents an exciting option for future directions in the percutaneous treatment of Fontan pathway obstruction.
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Background:
Patients with ccTGA have a high incidence of atrial arrhythmias and premature failure of the systemic right ventricle. We sought to better define this risk.
Methods:
A ...retrospective review of all clinical data for patients with ccTGA followed at a large tertiary care institution was performed. The primary outcome was a composite of death and cardiac transplantation.
Results:
A cohort of 165 patients (age 41±16 years, 53% male) were followed for 11±8 years; 41 patients died, 7 underwent cardiac transplantation, and 4 underwent VAD placement. Male sex (HR 2.7, p=0.002), older age (HR 1.04, p<0.001), clinical heart failure symptoms (HR 7, p<0.001), heart failure hospitalization (HR 4.9, p<0.001), syncope (HR 1.8, p=0.04) and pulmonary hypertension (HR 2.77, p<0.001) were significant predictors of the primary outcome. Atrial fibrillation (HR 3.5, p=0.002), atrial flutter (HR 3.05, p=0.04), and prolonged QRS duration (HR 1.01, p=0.004) on the first ECG, as well as right and left atrial enlargement (HR 4, p<0.001 and 3.7, p<0.003) and severe systemic AV valve regurgitation (HR 3.8, p=0.03) on the first echocardiogram were associated with poor outcomes.
Atrial arrhythmias occurred in 110(67%) patients: atrial fibrillation in 75(45%), atrial flutter in 50(30%), and supraventricular tachycardia in 16(9.7%) patients. Arrhythmias were largely asymptomatic in 109(66%) patients, while 25(14.5%) experienced palpitations, dizziness or presyncope, and 10(6%) presented with decompensated heart failure. Cardioversion and antiarrhythmic therapy were utilized in 53(32%) patients. Surgical pulmonary vein isolation or atrial MAZE were performed in 15(9%) patients, cryoablation of the CTI in 3 patients, and surgical ablation of an accessory pathway in 2 patients. One or more catheter ablation procedures were also performed in 18(11%) patients.
Conclusions:
Atrial fibrillation and flutter, heart failure, prolonged QRS duration, systemic AV valve regurgitation and pulmonary hypertension predict worse outcomes in ccTGA. Although asymptomatic in a majority of patients, atrial arrhythmias are associated with significant morbidity and mortality. Whether a rhythm control strategy even in asymptomatic patients may improve outcomes remains unknown.
Methodology: Retrospective observational study, in which the medical records of hospitalized patients at the Hospital Universitario San Vicente Fundación (HUSVF) in the city of Medellin, Colombia, ...from January 2011 to December 2017 were analyzed. Materials and Methods A retrospective observational study was carried out of the registration of the medical records of patients evaluated in the HUSVF of Medellín, Colombia (fourth level reference hospital), with diagnosis of MGJ according to clinical manifestations, the presence of antibodies, alterations in electromyography, response to drug administration and clinical tests, from January 1, 2011 to December 31, 2017. According to the distribution by age group, 65.2% were in the prepubertal group. 60.9% of the population was female. When evaluating age group and type of presentation with Fisher's exact test, a significant difference was found (p <0.0214), with OR of 9, in prepubertal patients to present MGO and in post pubertal patients to present MGG (Table 1).
The medieval outlaw appears in historical, religious, and legal texts of late Medieval England and is imagined in fiction as well, specifically in the romance narratives of Geoffrey Chaucer and ...Thomas Malory. Outlawry was a legal state that could be imposed. Both Chaucer and Malory, especially the latter, found themselves outside the law at different points of their lives, an item to consider when examining the authors’ representation of knights acting outside the chivalric code. Both authors populate their romances with outlawry, illustrating the ethical, legal, and social assumptions of their own times. In Chaucer and Malory, knights can sometimes be outlaws, and when they are, they are often portrayed as running amok or going mad, leading them to a quest or to an act that must be completed before they can be reintroduced into society. Early critics Maurice Keen and Eric Hobsbawm narrowly defined what they saw as outlawry in medieval literature, but the more recent work of Timothy S. Jones renews the possibility of better examining outlawry's intersection with medieval romance. Outlawry has traditionally been associated with the narratives of Robin Hood, who is traditionally depicted as an outlaw wearing green who robbed the rich and gave to the poor. Yet broadening the definitions of what constitutes an outlaw narrative can lead to fresh readings of Chaucer's and Malory's work. To be outlawed, in medieval fiction, carries with it an additional displacement of a character's human connection to others. In this project, I examine fictional knights tarrying in outlawed space while grounding my argument in historical narratives. In doing so, I illuminate how outlawry intersects with medieval romance, unveiling chivalry's ideological blemishes.
In my dissertation, I examine the representation of prostitution in the novels of twentieth-century Mexicana writers. This study will focus on what I call the Mexicana novel of prostitution, texts ...that feature female protagonists who have been compelled to enter the profession of prostitution out of necessity for financial or personal reasons. Examples of this genre that I analyze include Antonia Mora's "Del oficio" (1972), Sarah Sefchovich's Demasiado amor (1990), and Cristina Rivera Garza's Nadie me verá llorar (1999). Although the Mexicana novels of prostitution in some ways are a continuation of the social and historical approach to prostitution established in the nineteenth century, they constitute a literary genre that dialogues and also breaks with the male-authored literary discourses of the past. In Chapter One, I examine the expansion and industrialization of Paris, London, Madrid, New York, and Mexico City along with the emergence of the male novel of prostitution in this socio-historical context. I also consider legislation that emerged during the nineteenth century to control prostitutes. These important components of the emergence of the modern city are examined in order to establish the literary, social, and historical background of the Mexicana novel of prostitution. In Chapter Two, I focus on Antonia Mora's Del oficio (1972). In this urban testimonio, Mora professes to be a strong authority on the subject of prostitution, based on her personal experience. Because her novel is in no way a moralizing tale but rather is an honest portrayal of life in "el oficio," a life that has not been appropriated by anyone else, I assert that a strong distinction can be made between Mora's work and that of the male authors that precede her. In Chapter Three, I focus on Sara Sefchovich's Mexicana novel of prostitution, Demasiado amor (1990), as a response to and a dramatic departure from the Mexican literature of the mid-eighties. I conclude this chapter by analyzing the novel's relation to Sefchovich's most recent work of fiction, Vivir la vida (2000), positing that in both works the main characters live lives shaped mostly by oppressive circumstances that they are unable to escape, even in exile and death. The author uses her novels to reflect on the fact that the situation of women in Mexico has not sufficiently improved. In Chapter Four, I examine Cristina Rivera Garza's Nadie me verá llorar (1999), arguing that her identity as a fronteriza writer with a Chicana/Latina sensibility shapes her novel. Indeed, the novel presents within itself a theory of what a novel should be; it is an "interview" and exploration of a historical document that merges photography, history, and the author's own written voice and lived experience. Finally, Chapter Five, analyzes the current state of prostitution in Mexico City and reflects on the state of Mexican Feminism manifested in the Mexicana novel of prostitution and in the streets through the activism of mujeres "en la vida."
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