Background
Young implantable cardioverter defibrillator (ICD) recipients have a high rate of complications, some of which seem to be underestimated. We report our clinical experience with ICD therapy ...in children and young adults during a 15 year follow up.
Methods
We reviewed the database of ICD recipients at the present institution and chose 73 consecutive patients who underwent implantation at age 6–21 years. We analyzed intervention rate, mortality, rate and characteristics of complications and treatment options.
Results
A total of 20/73 patients (27.4%) received ≥1 episode of appropriate therapy (AT) for ventricular tachycardia/ventricular fibrillation (anti‐tachycardia pacing or shock) and 24/73 patients (32.8%) had one or multiple episodes of inappropriate therapy (IT). Eight patients (11%) had both interventions: AT + IT. A total of 15/73 patients (20.5%) had ventricular lead dysfunction, with 13 re‐implantations (17.8%) of a new system. Four of 73 patients (5.5%) had infection: endocarditis or device pocket infection. A total of 2/73 patients (2.7%) died due to ventricular lead dysfunction, while 22/73 patients (30.1%) needed elective device replacement, five of them twice (6.8%).
Conclusion
Endocardial ICD implantation in children and young adults is a feasible and life‐saving procedure, according to the present 15 year follow up. The rate of complications including IT was high: 72.8% in the young ICD recipients. Re‐implantation of a new system was often required due to ventricular lead dysfunction or infection in 25% of the patients.
Cholestasis is characterised by impaired bile secretion and accumulation of bile salts in the organism. Hereditary cholestasis is a heterogeneous group of rare autosomal recessive liver disorders, ...which are characterised by intrahepatic cholestasis, pruritus, and jaundice and caused by defects in genes related to the secretion and transport of bile salts and lipids. Phenotypic manifestation is highly variable, ranging from progressive familial intrahepatic cholestasis (PFIC)—with onset in early infancy and progression to end-stage liver disease—to a milder intermittent mostly nonprogressive form known as benign recurrent intrahepatic cholestasis (BRIC). Cases have been reported of initially benign episodic cholestasis that subsequently transitions to a persistent progressive form of the disease. Therefore, BRIC and PFIC seem to represent two extremes of a continuous spectrum of phenotypes that comprise one disease. Thus far, five representatives of PFIC (named PFIC1-5) caused by pathogenic mutations present in both alleles of ATP8B1, ABCB11, ABCB4, TJP2, and NR1H4 have been described. In addition to familial intrahepatic cholestasis, partial defects in ATP8B1, ABCB11, and ABCB4 predispose patients to drug-induced cholestasis and intrahepatic cholestasis in pregnancy. This review summarises the current knowledge of the clinical manifestations, genetics, and molecular mechanisms of these diseases and briefly outlines the therapeutic options, both conservative and invasive, with an outlook for future personalised therapeutic strategies.
Blastocystis hominis is one of the most common parasites present in the human gastrointestinal tract. Transmission usually occurs via food and water contaminated with cystic forms or via the ...faecal-oral route. The prevalence of infection is approximately 30–50% in developing countries and about 1.5–10% in developed ones. Blastocystis hominis was long considered as a large intestine commensal due to asymptomatic infestation, possibly characterised by temporary or permanent gastrointestinal carrier state, in some cases. Currently, this protozoan is considered pathogenic as symptoms develop in the course of infestation, especially in infected immunocompromised individuals. The importance of Blastocystis hominis as a factor responsible for enteral and parenteral symptoms is underestimated in clinical practice, and the infestation with this parasite is underdiagnosed. We present a case of a 5-year-old boy infected with Blastocystis hominis, who developed gastrointestinal symptoms and urticaria.
The article aims to contribute to the discussion on gender stereotypes in stories for children by mapping gender stereotypes in traditional fairy tales. The article presents fairy tales' value in ...children’s education and indicates potential dangers in traditional cultural transmissions, paying special attention to gender stereotypes. A selection of texts was analyzed in terms of their stereotypical gender portrayals. The methodological framework represents an interpretative paradigm in social sciences, using a qualitative method of analysis. The texts were purposely selected, and the most popular fairy tales were chosen: Cinderella, Snow White and Sleeping Beauty, which despite the passing of time, are still popular, widely read and also used in film adaptations. It was shown that in all analyzed fairy tales, there was a stereotypical division of roles according to gender. The article also presents possible ways to counteract gender stereotypes. A limitation of the article is that the analysis is limited to three fairy tales only, but the overarching value raises awareness of gender stereotypes in fairy tales for children.
BACKGROUND Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of ongoing progress, they remain a significant cause of morbidity. In children, the majority ...of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of this study was to analyze our experience in percutaneous transhepatic treatment of BS. MATERIAL AND METHODS Between 1998 and 2014, 589 (269 living donor) pediatric LTx were performed in our institution. We retrospectively reviewed clinical data of patients with HJA who developed BS and who underwent percutaneous transhepatic biliary drainage (PTBD). RESULTS Out of 400 patients with HJA, 35 patients developed BS. There were 27 cases (77%) of anastomotic BS (ABS) and 8 cases (23%) of multilevel BS (MBS). Ninety-two PTBD sessions (2.5 per patient) were performed, with successful outcomes in 20 cases (57%). Fifteen patients, after failed PTBD, underwent surgery which was successful in 11 cases. Overall good outcomes were achieved in 31 cases (88.5%). The most common complication of PTBD was cholangitis which occurred in 5.4% of the cases. We did not find any risk factors for PTBD failure, except for treatment occurring before 2007. CONCLUSIONS Percutaneous treatment is effective and safe in BS and is recommended as a first-line approach. The majority of patients in our study required multiple interventions, however, the overall risk of complications was low. Surgery is essential in selected cases and always should be considered if PTBD fails.
Deciphering the evolution of marine plankton is typically based on the study of microfossil groups. Cryptic speciation is common in these groups, and large intragenomic variations occur in ribosomal ...RNA genes of many morphospecies. In this study, we correlated the distribution of ribosomal amplicon sequence variants (ASVs) with paleoceanographic changes by analyzing the high-throughput sequence data assigned to Neogloboquadrina pachyderma in a 140,000-year-old sediment core from the Arctic Ocean. The sedimentary ancient DNA demonstrated the occurrence of various N. pachyderma ASVs whose occurrence and dominance varied through time. Most remarkable was the striking appearance of ASV18, which was nearly absent in older sediments but became dominant during the last glacial maximum and continues to persist today. Although the molecular ecology of planktonic foraminifera is still poorly known, the analysis of their intragenomic variations through time has the potential to provide new insight into the evolution of marine biodiversity and may lead to the development of new and important paleoceanographic proxies.
The seawater microbiome is crucial in marine ecosystems because of its role in food chains and biogeochemical cycles; thus, we studied the composition of the pelagic marine microbiome collected in ...the upper 50 m on the opposite sides of Fram Strait: Spitsbergen and Greenland shelves. We found out that it differed significantly, with salinity being the main environmental variable responsible for these differences. The Spitsbergen shelf was dominated by Atlantic Waters, with a rather homogenous water column in terms of salinity and temperature down to 300 m; hence, the marine microbial community was also homogenous at all sampled depths (0, 25, 50 m). On the contrary, stations on the Greenland shelf were exposed to different water masses of both Arctic and Atlantic origin, which resulted in a more diverse microbial community there. Unexpectedly, for the very first time, we identified cyanobacterium Prochlorococcus marinus in Arctic waters (Spitsbergen shelf, 75–77° N). Till now, the distribution of this cyanobacteria in oceans has been described only between 40° N and 40° S. Considering the accelerated rate of climate warming in the Arctic, our results indicated that the seawater microbiome can be viewed as an amplifier of global change and that the Atlantification is in progress.
Liver transplant recipients are at increased risk of oxidative stress due to pre-existing liver failure, ischemia-reperfusion injury, functional impairment of graft, rejections and immunosuppression. ...Despite the use of several methods of measurement, it is still unclear how oxidative stress correlates with tissue injury and clinical complications. In this review we discuss pathogenesis, methods of measurement, possible complications and antioxidant treatment in liver transplant recipients.
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