Background: Maternal IgG antibodies can pass through the placental barrier to the fetal circulation, and may sensitize fetal red cells when there is maternal-fetal blood type incompatibility. The pathogenesis of breast milk jaundice is not yet clear. Few studies have focused on hemolytic disease of the newborn (HDN) associated with passively-acquired maternal antibodies from breast milk, for which individual cases were occasionally reported in recent years. Case Report: Five newborns were found to develop jaundice 19 hours to 4 days after birth. These affected neonates were enrolled in a study to test free antibodies in plasma and antibodies bound to the surface of red blood cells, as well as antibodies in their mothers’ blood and breast milk. The data were analyzed in combination with the mothers’ antibody monitoring records during pregnancy. Methods: 3 mL of EDTA-anticoagulated venous blood was collected from each affected neonate and 5 mL from his/her mother to separate plasma. The plasma was incubated with panel cells in normal saline in test tubes at 37 °C for 45 min, and then added to anti-human globulin micro-column gel cards and centrifuged to observe the results. 100–200 mL of the whey separated from breast milk was used in a two-stage papain technique: 50 μL of panel cells was incubated with 50 μL of 1% papain at 37 °C for 10 min, then washed once with normal saline and prepared to a 3–5% cell suspension; the cell suspension was incubated with 200–300 μL of whey at 37 °C for 30 min, then washed 3 times with normal saline and prepared to a 0.8–1% cell suspension. 50 μL of the resultant suspension was added to anti-human globulin micro-column gel cards and centrifuged to observe the results. In addition, an antibody elution test was conducted on the red blood cells of the affected neonates. Results: The antibodies in the red blood cell eluate of the affected neonates were consistent with those in the maternal blood and breast milk. The antibodies acquired in case 1 can immediately be considered irrelevant to the placental route. Conclusion: Anti-erythrocyte IgG antibodies may result from breast milk and cause red blood cell sensitization in newborns. For children with severe HDN, restrictions on breastfeeding should be considered to prevent continuous antibody acquisition.

Soil aggregates are the basic unit structing soils, and their stability is an important index for soil degradation. However, current methodologies rarely assess the influence of primary soil particles on soil aggregates distribution for different breakdown mechanisms. Therefore, a new method that separates the primary soil particles from the soil aggregates for different breakdown mechanisms with a series of in-lab experiments were developed to fill this gap. The whole soil sample was treated by fast wetting, slow wetting, and mechanical breakdown by pre-wetting and stirring to simulate the different breakdown mechanisms of slaking, differential swelling of clays, and mechanical breakdown by raindrop impact, respectively. Then, attempts were made to separate the primary soil particles from the soil aggregates of various particle size fractions by using sodium hexametaphosphate and hydrogen peroxide to eliminate the influence of the primary soil particles on the soil aggregate distribution. Four soils collected from different areas with different soil textures were used to assess the soil aggregate distribution by using the new method to highlight the importance of separating the primary soil particles from the soil aggregate for different breakdown mechanisms. The results indicated that the primary soil particles have much greater influence on the micro-aggregates than on macro-aggregates. Different breakdown mechanisms and soil types could affect the influence of the primary soil particles affects the on soil aggregate distribution. This study highlights the influence of separate primary soil particles on soil aggregate distribution for different breakdown mechanisms.

Dear editor, we have read with interest the study by Deo et al.published in BJOG: An International Journal of Obstetrics and Gynaecology 1. We have noted that although the control and VR group were ‘comparable’ regarding previous hysteroscopies, differences in baseline pain expectation scores between patients with a previous hysteroscopy and those without were not given. Each patient has an individual pain experience during hysteroscopy, some may not experience any pain at all, whereas others feel pain during cervical manipulation, distension of the uterus, during pipelle biopsy or delayed pain due to the release of prostaglandins2. Therefore, it could be possible the VR group has patients who do not experience any pain at all. It would be beneficial to know if there was any difference in pain expectation scores between those with prior experience of hysteroscopy and those without. A further study with a group known to have painful hysteroscopies could be of immense clinical value, as this group of patients may experience the greatest benefit.Furthermore, it is mentioned that ‘patients were instructed to self administer analgesics prior to the procedure (either paracetamol or non steroidal anti-inflammatory drugs)’ . It would be useful to ask the patients which specific analgesic they took, the dosage and how long before the procedure they took the medication. As use of analgesia prior to the procedure could potentially affect the pain perceived and therefore the pain scores in both groups; potentially being a confounding factor. Having more information about analgesia used prior to the procedure could allow clinicians to identify significant differences between cohorts with regards to analgesia use and signify a possible correlation to pain scores.Finally, it is mentioned that one patient in the VR group had a previous history of claustrophobia and decided to remove the headset when the procedure started as she felt claustrophobic. Therefore, the patient would not have experienced VR throughout the procedure, rather only for a small period of time, potentially effecting the reported pain score for that patient and the larger results as study populations were only 20 patients per cohort. To avoid this, the patient could have perhaps not been included in the results.Disclosure of Interests: No conflicts to declare.Contribution to Authorship: All authors were involved in the conception, analysis, drafting of intellectual content and final approval of this correspondence letter. All authors are also in agreement to be accountable for all aspects of work in this correspondence letter.Details of Ethics Approval: No ethics approval required.Funding : No funding.

Zn deficiency is the most common micronutrient deficit in rice but also a widespread industrial pollutant. It is unclear how rice responds to Zn depletion or excess, and which signaling molecules link the affected physiological processes. We therefore compared the physiological, transcriptomic and biochemical properties of rice plants subjected to Zn starvation or excess at early and later treatment stages. Both forms of Zn stress inhibited root and shoot growth. Several divalent cations (Fe, Cu, Ca, Mn and Mg) accumulated in Zn-depleted shoots, possibly due to the increased synthesis and activity of promiscuous Zn transporters and chelators. Gene Ontology enrichment analysis of 970 differentially expressed genes revealed overrepresentation of ion and oligopeptide transport, antioxidative defense and secondary metabolism. The expression of genes encoding Fe/Ca-binding peroxidases was activated after 3 days of Zn starvation, boosting the activity of ascorbate peroxidase and thus scavenging H2O2 more effectively to prevent leaf chlorosis. Conversely, excess Zn triggered the expression of genes encoding Mg-binding proteins (OsCPS2/4 and OsKSL4/7) required for antimicrobial diterpenoid biosynthesis. We demonstrated the key components of crosstalk between Zn and other divalent cations under Zn stress conditions, leading to the regulation of gene expression and corresponding biochemical and physiological processes.

Objective: We aimed to evaluate myocardial performance in fetuses with increased nuchal translucency. Method: Cases with increased NT without any associated structural anomalies were enrolled in this study. The study group consisted of 53 pregnancies complicated with thickened NT > 3.5 mm. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled in the study as the control group. The TEI index was evaluated before performing CVS in the group with an increase in NT. Karyotype analysis was performed via CVS in all patients with increased NT. In both groups, detailed fetal sonographic examinations, including fetal echocardiograms, were performed between 18 and 24 weeks of gestation. Results: The differences between normal and increased NT groups in terms of isovolumetric relaxation time (IRT), ejection time (ET), and myocardial performance index (MPI) variables were found to be statistically significant (p values of 0.023, 0.004, and < 0.001, respectively). For IRT and MPI variables, the median values of the group with an increase in NT were found to be significantly higher than that of the normal NT group, whereas the median value of the ET variable of the group with increased NT was significantly lower than that of the normal NT group Conclusion: The MPI significantly increased in the group with increased NT, but no difference was observed between those with and without Down syndrome. This suggests that increased NT is caused by cardiac dysfunction, whether or not Down syndrome is present.

Desert mosses withstand intense sunlight while desiccated and metabolically inactive. We used in situ field experiments to uncover the effects of natural and reduced levels of UV radiation on maximum Photosystem II (PSII) quantum efficiency (Fv/Fm) and on the relative abundance of photosynthetic pigments and antioxidants in Syntrichia caninervis. We tested the hypothesis that if UV is a stressor, reduction of natural UV levels will result in increased photosynthetic efficiency, but that such reduction will de-harden plants and increase vulnerability to PSII damage with UV exposure. We also measured photosynthetic efficiency over a simulated winter recovery period to assess sustained non-photochemical quenching (NPQ) and its subsequent relaxation. Finally, we measured the effect of UV reduction on photosynthetic pigment and antioxidant abundance. All field-collected plants had low Fv/Fm at collection but recovered over eight days in winter conditions. Plants in the low-UV treatment had lower Fv/Fm during recovery than those exposed to natural UV levels and had higher zeaxanthin, lutein, tocopherols, and a higher ratio of chlorophyll a to chlorophyll b. Natural S. caninervis undergoes sustained NPQ that takes days to relax and for efficient photosynthesis to resume. Reduction of UV radiation from sunlight has adverse effects on recovery of Fv/Fm.

Abstract: Recurrent pregnancy loss (RPL) is a prominent reproductive disease that distresses about 2%-5% of couples. RPL is the loss of two or more successive spontaneous pregnancies prior to 20th week of the embryo development. The commencement of pregnancy necessitates implantation of the embryo into responsive maternal decidua synchronized with the process of placentation, decidual and myometrial trophoblast incursion as well as refashioning of spiral blood arteries of uterus. The collapse of any of the processes fundamental for accomplishment of pregnancy may result into an array of pregnancy problems including spontaneous pregnancy loss. Human female with normally working immune system may well carry a partly-allogenic embryo to full tenure with no apparent rejection via adjustment of the immune system so as to accept and tolerate the embryo. The endometrium of human female manufactures an extensive range of cytokines during the proliferative and secretory stage of menstrual cycle. These endometrial cytokines are thought as major players for making the uterus ready for embryo implantation and placental development. Decidual cytokines regulate the invasion of trophoblast and remodeling of spiral arteries as well as take part in immune suppression to accomplish the pregnancy. Deterrence of fetal dismissal by the mother needs a regulated milieu, which takes place essentially at the embryo-maternal interface and the tissues of uterus. The reasons of RPL remain anonymous in a large number of cases that leads to difficulties in management and severe trauma in couples. Further study of novel factors is wanted to establish treatment protocols for RPL.

Background: The improved life expectancy observed in patients living with Human Immunodeficiency Virus (HIV) infection has made age-related cardiovascular complications, including arrhythmias, a growing health concern. We describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS) Methods and Results: Data on HIV-related hospitalizations from 2005 to 2014 were obtained from the NIS using International Classification of Diseases, 9th Revision (ICD-9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without arrhythmia. Baseline demographics and comorbidities were determined. Outcomes including in-hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, North Carolina) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients. Among 2,370,751 HIV-related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100,000). The overall frequency of arrhythmias has increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile and non-elective admissions. Patients with arrhythmias had a higher in-hospital mortality rate (9.6%). In-hospital mortality among patients with arrhythmias has decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia-related hospitalizations were mostly unchanged. Conclusions: Arrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.

Introduction: Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods: We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent atrial fibrillation, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of <0.5 mV covering ≥5 cm2 of the left atrium. Results: LVAs were present in 206 (21%) patients. The SPEED score was obtained as the total number of independent predictors as identified on multivariate analysis, namely female sex (odds ratio (OR) 3.4 [95% confidence interval (CI) 2.2-5.2], p <0.01), persistent AF (OR 1.8 [95% CI 1.1-3.0], p=0.02), age ≥70 years (OR 2.3 [95% CI 1.5-3.4], p <0.01), elevated brain natriuretic peptide ≥100 pg/ml or N-terminal pro-brain natriuretic peptide ≥400 pg/ml (OR 1.7 [95% CI 1.02-2.8], p=0.04), and diabetes mellitus (OR 1.8 [95% CI 1.1-2.8], p=0.02). LVAs were more frequent in patients with a higher SPEED score, and prevalence increased with each additional SPEED score point (OR 2.4 [95% CI 2.0-2.8], p <0.01). Conclusion: The SPEED score accurately predicts the prevalence of LVAs in patients undergoing ablation for AF.

The relationship between the speed of sound (u) in biodiesel and the change in Gibbs energy (ΔG) has not been describe in literature. With the Gibbs energy additivity (GEA ) method, the relation between u and ΔG can be expressed as lnu2 = ΔG/RT + A, where R is the universal gas constant; T is absolute temperature and A is constant. Further expansion of the G to its enthalpy and entropy, and sub-division the molecule of a fatty and methyl ester (FAME) into groups of atoms, the final model was good for estimation the speed of sound in both FAME and biodiesel at various temperatures. Only numbers of double bond and carbon atoms of fatty acid were required for the calculation.

The cell culture is the central piece of a biotechnological industrial process. It includes upstream (e.g. media preparation, fixed costs, etc.) and downstream steps (e.g. product purification, waste disposal, etc.). In the continuous mode of cell culture, a constant flow of fresh media replaces culture fluid until the system reaches a steady state. This steady state is the standard operation mode which, under very general conditions, is a function of the ratio between the cell density and the dilution rate and depends on the media supplied to the culture. To optimize the production process it is widely accepted that the concentration of the metabolites in this media should be careful tuned. A poor media may not provide enough nutrients to the culture, while a media too rich in nutrients may be a waste of resources because, either the cells do not use all of the available nutrients, or worse, they over-consume them producing toxic byproducts. In this work we show how an in-silico study of a genome scale metabolic network coupled to the dynamics of a chemostat could guide the strategy to optimize the media to be used in a continuous process. Given a known media we model the concentrations of the cells in a chemostat as a function of the dilution rate. Then, we cast the problem of optimizing the production process within a linear programming framework in which the goal is to minimize the cost of the media keeping fixed the cell concentration for a given dilution rate in the chemostat. We evaluate our results in two metabolic models: first a simplified model of mammalian cell metabolism, and then in a realistic genome-scale metabolic networks of mammalian cells, the Chinese Hamster Ovary (CHO) cell line. We explore the latter in more detail given specific meaning to the predictions of the concentrations of several metabolites.

A document by Cristine Rosário. Click on the document to view its contents.

Few studies have comprehensively evaluated the effect of changing land use on the soil quality in Ecuadorian amazon region that subject to continued deforestation processes. This study evaluated the influence of different types of land use on soil quality using an integrated soil quality index (SQI) with minimum set of indicators, based on 140 soil samples from 7 land use types, in seven productive distinct landscapes in the Pastaza province, Ecuador. The land use type evaluated were: Chakra_A, Chakra_B, Chakra_C, Cattle_A, Cattle_B, Cattle_C and Forest. Land use type had significant effects on soil properties and thus on soil quality. Soil quality index was developed by using, AP, Zn, TOC, BD and LL; AP and Zn had highest weighting values (0.38), which indicated that these indicators contributed the most to final SQI. In general, the SQI decreased as soil depth increased and for each type of land use, in the surface layer (0-10cm) the uses of Chakra_A (0.46) and forest (0.44) showed the highest SQI, while for the second depth (10-30cm), Chakra_A (0.45) and Chakra_B (0.43) presented significantly higher SQIs than the other land uses. The applied SQI can be used to assess the effect of changes on land use on soil quality in other landscapes of the Ecuadorian Amazon Region.

The basophil activation test (BAT) is a functional assay that measures the degree of degranulation following stimulation with allergen or controls by flow cytometry and is directly correlated with histamine release. From the bell-shaped curve resulting from BAT in allergic patients, basophil reactivity (given by %CD63+ basophils) and basophil sensitivity (given by EC50 or similar) are the main outcomes of the test. BAT takes into account all characteristics of IgE and allergen and thus can be more specific than sensitization tests in the diagnosis of allergic disease. BAT reduces the need for in vivo procedures, such as intradermal tests and allergen challenges, which can cause allergic reactions of unpredictable severity. As it closely reflects the patients’ phenotype, it can potentially be used to monitor the natural resolution of food allergies and to predict and monitor clinical response to immunomodulatory treatments, such as allergen-specific immunotherapy and biologicals. Clinical application of BAT requires analytical validation, clinical validation, standardization of procedures and quality assurance to ensure reproducibility and reliability of results. Currently, efforts are ongoing to establish a platform that could be used by laboratories in Europe and in the USA for certification.

In November 2019, section 4.6 of the ondansetron Summary of Product Characteristics (SmPC) was revised by the European Medicines Agency (EMA). It explicitly states, “ondansetron should not be used during the first trimester of pregnancy” (Ondansetron, SmPC[cited 2020 July 08]. Available from: https://www.medicines.org.uk/emc/). Ondansetron is an effective antiemetic drug commonly prescribed as a second-line treatment for severe Nausea and Vomiting of Pregnancy (NVP) (Fiaschi L et al,BJOG 2019;126:1201–11; Oliviera L et al. Obstet Gynecol2014;124:735-42). We do not believe that the underlying evidence supports a strong regulatory discouragement.Tightening of the SmPC on the use during pregnancy follows EMA assessment of two large pharmacoepidemiological studies, each comprising more than 80,000 first trimester pregnancy exposed liveborn children.In a methodologically meticulous pharmacoepidemiological study, Huybrechts et al. studied malformation outcomes among 88,000 liveborn children exposed to ondansetron in the first trimester. Comparing to 1,727,000 unexposed liveborn, they used comprehensive propensity score adjustments for their inferential analysis. Adjusted relative risks were 1.01 (95% CI 0.98-1.05) for any malformation, 0.99 (95% CI 0.93-1.06) for cardiac malformations and 1.24 (95% CI 1.03-1.48) for oral clefts (Huybrechts et al. JAMA 2018;320:2429–37).Subject to substantial academic controversy, Zambelli-Weiner et al. reported data on 82,000 liveborn children exposed to ondansetron in the first trimester (Zambelli-Weiner et al. Reprod Toxicol2019;83:14–20). Overall, they reported a small excess risk of cardiac malformations with an adjusted odds-ratio (aOR) of 1.04 (95% CI 1.00-1.08) and a weak association with orofacial clefts, aOR 1.12 (95% CI: 0.95-1.33). When restricting exposure to about 5,500 women who were administered ondansetron in a hospital setting, the vast majority of which comprised a single intravenous dose, aOR was 1.43 (95% CI 1.28-1.61) for cardiac malformations and 1.30 (95% CI: 0.75-2.25) for orofacial clefts. This study is substantially flawed and we argue it should not be considered when weighing the totality of evidence on the safety of ondansetron in pregnancy due to: 1) strong selection bias 2) poor external validity (the cardiac malformation rate of 3.7% was extraordinarily high among 780,000 unexposed controls) 3) inadequate adjustment for confounders and covariates and, importantly, 4) serious conflict of interest (Schachtman Law. Re: Zambelli-Weiner [cited 2020 July 8]. Available from: http://schachtmanlaw.com/litigation-science-in-re-zambelli-weiner/ )In summary, robust clinical data suggest 1) no overall increased risk of major malformations 2) no increased risk of cardiac malformations 3) a small excess risk of oral clefts corresponding to three additional cases of oral cleft for every 10,000 liveborn children exposed to ondansetron in the first trimester of pregnancy (figure 1).NVP causes significant physical and psychological morbidity to the degree that some women contemplate termination of pregnancy. Denying such patients effective and low-risk treatment is inappropriate. We are confident that women suffering from severe NVP can comprehend the small excess risk of oral clefts in making an informed decision. The statement “ondansetron should never be used in pregnancy” is: 1) misconceived 2) insufficiently substantiated by evidence and 3) not in the best interest of pregnant women.

Abstract: Armadillos are specialist diggers and their burrows are used to find food, seek shelter and protect their pups. These burrows can also be shared with dozens of vertebrate and invertebrate species and; consequently, their parasites including the zoonotics. The aim of this study was to diagnose the presence of zoonotic parasites in four wild-caught armadillo species from two different Brazilian ecosystems, the Cerrado (Brazilian savanna) and the Pantanal (wetland). The investigated parasites and their correspondent diseases were: Toxoplasma gondii (toxoplasmosis), Trypanosoma cruzi (Chagas disease), Leishmania spp., (leishmaniasis), Paracoccidioides spp. (Paracoccidioidomicosis) and Mycobacterium leprae (Hansen’s disease). Forty-three free-living armadillos from Pantanal and seven road-killed armadillos from the Cerrado were sampled. Trypanosoma cruzi DTU TcIII were isolated from 2 out of 43 (4.65%) armadillos, including one of them also infected with Trypanosoma rangeli. Antibodies anti-T. gondii were detected in 13 out of 43 (30.2%) armadillos. All seven armadillos from Cerrado tested positive for Paracoccidioides brasiliensis DNA, in the lungs, spleen, liver and ear fragments. Also, by molecular analysis, all 43 individuals were negative for M. leprae and Leishmania spp. Armadillos were infected by T. cruzi, T. rangeli, P. brasiliensis, and presented seric antibodies to T. gondii, highlighting the importance of those armadillos could have in the epidemiology of zoonotic parasites. Key words: Cingulata, Trypanosoma cruzi, Toxoplasma gondii, Paracoccidioides brasiliensis, Mycobacterium leprae, Leishmania sp.

Objectives: To evaluate universal SARS-CoV-2 screening in labouring women in a tertiary hospital in the Netherlands. Women with an unknown SARS-CoV-2 were treated as COVID-19 positive in theatre. As COVID-19 precautions differed from standard care, this may have contributed to adverse perinatal outcomes. Methods: Women admitted to the labour- and pregnancy ward were consecutively asked for COVID-19 symptoms and then screened for SARS-CoV-2 by PCR. Results: From March 5 2020 to May 13, 283 women without COVID-19 symptoms were screened. One post-symptomatic woman was excluded from the analysis. 3/ 282 women (1.1%) tested positive for SARS-CoV-2. In one woman, a pending SARS-CoV-2 test, may have worsened perinatal asphyxia in her child, and in two other cases with post-partum haemorrhage the prolonged decision-to intervention interval may have contributed to more blood loss. Conclusion: Caretakers should balance the potential additional perinatal risks of alternative care processes for unscreened SARS-CoV-2 patients in obstetric emergencies.

In September 2018, Wiley began a collaborative pilot initiative with Publons and ScholarOne (part of Clarivate, Web of Science) to open up the peer review process by offering transparent peer review as an opt-out for authors on submission to a journal. If a journal article is published, then the peer reviewers’ reports, authors’ responses, and editors’ decisions accompany the published article. Reviewers also have the option to disclose their names alongside their reports but this is not mandatory.  We wanted to learn how the initiative was working and understand the effect of introducing transparent peer review in terms of journal turnaround times and willingness of reviewers to agree to review.  We present data from 27 journals across a range of subject disciplines that have participated in the pilot for at least six months. We compared our findings with 29 comparable 'control' journals that did not introduce transparent peer review for the same time period. By considering a total of 74160 submissions we measured changes both pre- and post- the introduction of transparent peer review. We found that on average 86% of authors remained opted-in to a transparent peer review process.  The majority of reviewers were willing to publish the content of their reports, however only 15% of reviewers agreed to sign their reports. Transparent peer review did not have an impact on journal turnaround times or the number of revisions authors made. However, editors had to invite more peer reviewers in order to secure a sufficient number of reviewers to agree to review an article, increasing editorial effort. Overall, these results suggest that transparent peer review is feasible across journals in different subject disciplines and is not detrimental to editorial decision times. We think that the benefits of introducing transparent peer review, in terms of  trust and accountability for the peer review process and recognition for the work of editors and reviewers, outweigh any practical concerns against it.  

Transcatheter valve-in-valve implantation may be considered in patients with failing surgical bioprosthesis caused by severe regurgitation or stenosis, regardless of sur¬gical valve position. This case report presents a 70-years-old woman presenting with worsening dyspnea, according to New York Heart Association (NYHA) Class III, after she had received a Sorin Perceval® S sutureless valve due to severe aortic valve stenosis one year ago. Echocardiography revealed severe valvular aortic regurgitation and stenosis. Instead of reoperation, the transcatheter valve in the valve procedure was planned. Here we present the first case of the trans-femoral implant of a self-expandable (Portico) aortic valve in a leaking sutureless self-expandable valve.

Incidentally Discovered Cor Triatriatum Sinistrum Anomaly During Heart Transplant

Abstract Due to the technical necessity to enter the aortic arch during surgery for aortic dissection type A, the brain must be protected optimally to avoid damage to our most precious organ. The different options are reviewed starting with deep hypothermic circulatory arrest which was the first technique described to protect the brain. Its major advantage is the bloodless surgical field and its simplicity but the time constraints limit its application in complex and extended repairs. Therefore antegrade cerebral perfusion has actually become much more popular because this technique allows for much longer arrest periods in which the brain is perfused in a physiological manner reducing the cerebral complications after surgery. Pros and cons of the existing techniques are discussed.

Background: Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist. Objectives: We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to ≥30 days between March 2019 and March 2020. Methods: Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-Do-Study-Act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders. Results: The 24-month baseline period included 30 patients that died and 25 newly diagnosed patients. The yearlong intervention period included 6 patients that died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC ≥ 30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult within 30 days after diagnosis, 17% had template documentation of the rationale. Conclusion: Interventions utilized met the global aim, outcome and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.

Introduction: Access to public healthcare is limited in Brazilian underserved areas, and long waiting lists remain for echocardiography (echo). We aimed to develop a tool to optimize indications and shorten waiting lists for standard echo in primary care. Methods: Patients in waiting list for standard echo were enrolled. For derivation, patients underwent a clinical questionnaire, simplified 7-view echo screening by non-physicians with handheld devices (GE-VSCAN), and standard echo (Vivid-Q) by experts. Two models were adjusted, one including clinical variables and other adding screen-detected major heart disease (HD). For validation, patients were risk-classified according to the clinical score. High-risk patients and a sample of low-risk underwent standard echo. Intermediate-risk patients first had screening echo, with a complete study if HD was suspected. Discrimination and calibration of the 2 models were assessed to predict HD in standard echo. Results: In derivation (N=603), clinical variables associated with HD were female gender, body mass index, Chagas disease, prior cardiac surgery, coronary disease, valve disease, hypertension, and heart failure, and this model was well calibrated with C-statistic=0.781. Performance was improved with the addition of echo screening, with C-statistic=0.871 after cross-validation. For validation (N=1,526), 227 (14.9%) patients were classified as low-risk, 1082 (70.9%) as intermediate-risk, and 217 (14.2%) as high-risk by the clinical model. The final model with 2 categories had high sensitivity (99%) and negative predictive value (97%) for HD in standard echo. Model performance was good with C-statistic=0.720. Conclusion: The addition of screening echo to clinical variables significantly improves the performance of a score to predict major HD.

To study the compressive mechanical properties of a new type of brazed aluminum honeycomb plate (BAHP), tensile tests on single- and brazed-cell walls as well as compression tests in the out-of-plane, in-plane longitudinal, and transverse directions were conducted. Compared to the material properties of a traditional glued aluminum honeycomb plate (GAHP), those of the single- and brazed-cell walls of the BAHP are entirely different. Therefore, their characteristics should be considered separately when performing theoretical and simulation analysis. Under out-of-plane compression, the core of the BAHP did not debond, owing to its higher strength than that of the GAHP. In comparison, under in-plane compression in the longitudinal and transverse directions, the load–displacement characteristics, ultimate load, and failure modes also differed, and there was no large-scale cracking. Considering the characteristics of the BAHP, a strength prediction method was proposed. The simulation results demonstrated that the model built based on the new method was highly consistent with the experimental results.