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The safety of early post-operative cardiac catheterisation has been described following congenital heart surgery. Optimal timing of early post-operative cardiac catheterisation remains uncertain. The aim of this study was to describe the safety of early post-operative cardiac catheterisation and its impact on cardiac ICU and hospital length of stay, duration of mechanical ventilation, and extracorporeal support.
Methods:
This single-centre retrospective cohort study compared clinical and outcome variables between “early” early post-operative cardiac catheterisation (less than 72 hours after surgery) and “late” early post-operative cardiac catheterisation (greater than 72 hours after surgery) groups using Chi-squared, Student’s t, and log-rank test (or appropriate nonparametric test).
Results:
In total, 132 patients were included, 22 (16.7%) “early” early post-operative cardiac catheterisation, and 110 (83.3%) “late” early post-operative cardiac catheterisation. Interventions were performed in 63 patients (51.5%), 7 (11.1%) early and 56 (88.9%) late. Complications of catheterisation occurred in seven (5.3%) patients, two early and five late. There were no major complications. Patients in the late group trended towards a longer stay in the cardiac ICU (19 days [7, 62] versus 11.5 days [7.2, 31.5], p = 0.6) and in the hospital (26 days [9.2, 68] versus 19 days [13.2, 41.8], p = 0.8) compared to the earlier group.
Conclusion:
“Early” early post-operative cardiac catheterisation was associated with an overall low rate of complications. Earlier catheterisations trended towards shorter cardiac ICU and hospital length of stays. Earlier catheterisations may lead to earlier recovery for patients not following an expected post-operative course.
We present the first unbiased survey of neutral hydrogen absorption in the Small Magellanic Cloud. The survey utilises pilot neutral hydrogen observations with the Australian Square Kilometre Array Pathfinder telescope as part of the Galactic Australian Square Kilometre Array Pathfinder neutral hydrogen project whose dataset has been processed with the Galactic Australian Square Kilometre Array Pathfinder-HI absorption pipeline, also described here. This dataset provides absorption spectra towards 229 continuum sources, a 275% increase in the number of continuum sources previously published in the Small Magellanic Cloud region, as well as an improvement in the quality of absorption spectra over previous surveys of the Small Magellanic Cloud. Our unbiased view, combined with the closely matched beam size between emission and absorption, reveals a lower cold gas faction (11%) than the 2019 ATCA survey of the Small Magellanic Cloud and is more representative of the Small Magellanic Cloud as a whole. We also find that the optical depth varies greatly between the Small Magellanic Cloud’s bar and wing regions. In the bar we find that the optical depth is generally low (correction factor to the optically thin column density assumption of
$\mathcal{R}_{\mathrm{HI}} \sim 1.04$
) but increases linearly with column density. In the wing however, there is a wide scatter in optical depth despite a tighter range of column densities.
The National Science Foundation (NSF) Daniel K. Inouye Solar Telescope (DKIST) has started operations at the summit of Haleakalā (Hawai’i). DKIST joins the nominal science phases of the NASA and ESA Parker Solar Probe and Solar Orbiter encounter missions. By combining in-situ measurements of the near-Sun plasma environment and detailed remote observations of multiple layers of the Sun, the three observatories form an unprecedented multi-messenger constellation to study the magnetic connectivity in the solar system. This work outlines the synergistic science that this multi-messenger suite enables.
Little is known about Se intakes and status in very young New Zealand children. However, Se intakes below recommendations and lower Se status compared with international studies have been reported in New Zealand (particularly South Island) adults. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial compared a modified version of baby-led weaning (infants feed themselves rather than being spoon-fed), with traditional spoon-feeding (Control). Weighed 3-d diet records were collected and plasma Se concentration measured using inductively coupled plasma mass spectrometry (ICP-MS). In total, 101 (BLISS n 50, Control n 51) 12-month-old toddlers provided complete data. The OR of Se intakes below the estimated average requirement (EAR) was no different between BLISS and Control (OR: 0·89; 95 % CI 0·39, 2·03), and there was no difference in mean plasma Se concentration between groups (0·04 μmol/l; 95 % CI −0·03, 0·11). In an adjusted model, consuming breast milk was associated with lower plasma Se concentrations (–0·12 μmol/l; 95 % CI −0·19, −0·04). Of the food groups other than infant milk (breast milk or infant formula), ‘breads and cereals’ contributed the most to Se intakes (12 % of intake). In conclusion, Se intakes and plasma Se concentrations of 12-month-old New Zealand toddlers were no different between those who had followed a baby-led approach to complementary feeding and those who followed traditional spoon-feeding. However, more than half of toddlers had Se intakes below the EAR.
Early psychosocial adversities exist at many levels, including caregiving-related, extrafamilial, and sociodemographic, which despite their high interrelatedness may have unique impacts on development. In this paper, we focus on caregiving-related early adversities (crEAs) and parse the heterogeneity of crEAs via data reduction techniques that identify experiential cooccurrences. Using network science, we characterized crEA cooccurrences to represent the comorbidity of crEA experiences across a sample of school-age children (n = 258; 6–12 years old) with a history of crEAs. crEA dimensions (variable level) and crEA subtypes (subject level) were identified using parallel factor analysis/principal component analysis and graph-based Louvain community detection. Bagging enhancement with cross-validation provided estimates of robustness. These data-driven dimensions/subtypes showed evidence of stability, transcended traditional sociolegally defined groups, were more homogenous than sociolegally defined groups, and reduced statistical correlations with sociodemographic factors. Finally, random forests showed both unique and common predictive importance of the crEA dimensions/subtypes for childhood mental health symptoms and academic skills. These data-driven outcomes provide additional tools and recommendations for crEA data reduction to inform precision medicine efforts in this area.
Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
Rock debris covers ~30% of glacier ablation areas in the Central Himalaya and modifies the impact of atmospheric conditions on mass balance. The thermal properties of supraglacial debris are diurnally variable but remain poorly constrained for monsoon-influenced glaciers over the timescale of the ablation season. We measured vertical debris profile temperatures at 12 sites on four glaciers in the Everest region with debris thickness ranging from 0.08 to 2.8 m. Typically, the length of the ice ablation season beneath supraglacial debris was 160 days (15 May to 22 October)—a month longer than the monsoon season. Debris temperature gradients were approximately linear (r2 > 0.83), measured as −40°C m–1 where debris was up to 0.1 m thick, −20°C m–1 for debris 0.1–0.5 m thick, and −4°C m–1 for debris greater than 0.5 m thick. Our results demonstrate that the influence of supraglacial debris on the temperature of the underlying ice surface, and therefore melt, is stable at a seasonal timescale and can be estimated from near-surface temperature. These results have the potential to greatly improve the representation of ablation in calculations of debris-covered glacier mass balance and projections of their response to climate change.
Reducing multifactorial stunting is a priority for the 2025 WHO Global Nutrition Target. In the plant-based complementary diets of low-income countries, deficits in several growth-limiting micronutrients may contribute to stunting. Hence the intercorrelation between multiple micronutrients in terms of their intake and impact is important. Therefore, our aim was to develop a nutrient quality score using principal component analysis (PCA) in a sample of Indonesian infants at 6, 9 and 12 months of age and to evaluate the association of the scores with linear growth and stunting. At 6 months, 217 infants were recruited from Sumedang District, West Java, with 195 and 189 followed at 9 and 12 months of age, respectively. Complementary food intakes were assessed using 2-d weighed food records. Eight correlated nutrients (vitamin A, ascorbic acid, thiamine, riboflavin, niacin, Ca, Fe and Zn) were summarised using PCA into a single nutrient pattern that explained 56–65 % of the total variability. Nutrient quality scores were related to demographic, inflammation and complementary food indicator variables in hypothesised directions. While no significant relationships were apparent with linear growth, the odds of being stunted at ages 9 and 12 months was lower for infants with a higher nutrient quality score at 9 months (OR 0·75, 95 % CI 0·59, 0·95 and OR 0·69, 95 % CI 0·55, 0·88), respectively, for the fully adjusted models. A data-driven nutrient quality score is a valid tool to assess the influence of nutrient quality on stunting in at-risk infants.
We analyse the evolution with redshift of the radial gradient of oxygen abundances in spiral disks resulting from our MULCHEM chemical evolution models, computed for galaxies of different sizes or masses, studying the relationships between the gradients and galaxy characteristics as the stellar mass, the size, the gas fraction or the star formation rate for z < 4.
A small 33 ± 0.8 Ma lamproite pluton is exposed in the midst of a 23–26 Ma basalt-rhyolite province in Middle Park, NW Colorado. It contains abundant phlogopite phenocrysts in a fine-grained groundmass of analcime pseudomorphs after leucite, biotite, potassic richterite, apatite, ilmenite and accessory diopside. The phlogopite phenocryst cores contain ∼4 wt.% TiO2, 1% Cr2O3 and 0.2% BaO. The smallest groundmass biotites have normal pleochroism but compositions unlike any previously reported, with ∼2% Al2O3, ∼8% TiO2 and F <1.5%. Apart from those elements affected by leucite alteration, both the elemental and isotopic composition of this lamproite are close to those of the Leucite Hills, Wyoming. Its Nd-isotopic model age (TDM = 1.6 Ga) is outside the Leucite Hills range but within that of other Tertiary strongly potassic magmatism in the region underlain by the Wyoming craton. Evidence from both teleseismic tomography and the mantle xenoliths within other western USA mafic ultrapotassic igneous suites shows that the total lithospheric thickness beneath NW Colorado was probably ∼150–200 km at 33 Ma, when the Middle Park lamproite was emplaced. This is an important constraint on tectonomagmatic models for the Cenozoic evolution of this northernmost part of the Rio Grande rift system.
Cretaceous, strongly alkaline mafic igneous provinces occur around the margins of the Ordovician to Cretaceous Paraná sedimentary basin of southern Brazil. The Serra do Bueno diatreme is situated in the southern portion of the largest of these alkaline provinces, the Alto Paranaíba Igneous Province in Minas Gerais. The well-exposed diatreme crops out close to the south-west surface limit of the São Francisco craton and is adjacent to several other poorly exposed ultramafic alkaline pipes, previously described variously as kimberlites (Barbosa, 1991) and lamproites (Ramsay and Tompkins, in press). The diatreme has two distinct facies: (1) a crater facies dominated by lapilli tuffs; and (2) a magmatic hypabyssal facies formed by a relatively fresh ultramafic (MgO = 15 wt.%) potassic (K2O/Na2O = ∼ 1.5) intrusion that contains xenoliths of meta-sediments, feldspathic gneiss and dunite. It is massive and porphyritic, with large olivine phenocrysts (Fo87) and smaller crystals of diopside (Ca50Mg44Fe6), phlogopite, perovskite, ilmenite and zeolites in a fine-grained groundmass that contains altered leucite and up to 20% devitrified glass. The Serra do Bueno intrusion shows a strong enrichment in light relative to heavy rare earth elements, with La/Yb of ∼85. Its initial 87Sr/86Sr (0.705176) and 143Nd/144Nd (0.512312) isotopic ratios are similar to those of other intrusions (e.g. Limeira 2) and lavas (e.g. Presidente Olegário) in the Alto Paranaíba Igneous Province. This suggests that these Late Cretaceous alkaline magmas were all derived from a similar source, predominantly within the subcontinental lithospheric mantle.
Laser 40Ar/39Ar analyses have yielded an isochron of 90 ± 4 Ma for the Serra do Bueno intrusion. This age is higher than the corresponding K/Ar bulk-rock age for the same sample but similar to K/Ar ages determined on mica separates from both intrusive and extrusive rocks in the Alto Paranaíba Igneous Province.
Inflammation confounds the interpretation of several micronutrient biomarkers resulting in estimates that may not reflect the true burden of deficiency. We aimed to assess and compare the micronutrient status of a cohort of Indonesian infants (n 230) at aged 6, 9 and 12 months by ignoring inflammation (unadjusted) and adjusting four micronutrient biomarkers for inflammation with C-reactive protein (CRP) and α-1-glycoprotein (AGP) using the following methods: (1) arithmetic correction factors with the use of a four-stage inflammation model; and (2) regression modelling. Prevalence of infants with any inflammation (CRP>5 mg/l and/or AGP>1 g/l) was about 25% at each age. Compared with unadjusted values, regression adjustment at 6, 9 and 12 months generated the lowest (P<0·001) geometric mean (GM) for serum ferritin (26·5, 14·7, 10·8 μg/l) and the highest GM for serum retinol-binding protein (0·95, 1·00, 1·01 μmol/l) and Zn (11·8, 11·0, 11·5 μmol/l). As a consequence, at 6, 9 and 12 months regression adjustment yielded the highest prevalence of Fe deficiency (20·3, 37·8, 59·5 %) and the lowest prevalence of vitamin A (26·4,16·6, 17·3 %) and Zn (16·9, 20·6, 11·0 %) deficiency, respectively. For serum Se, irrespective of adjustment, GM were low (regression: 0·73, 0·78, 0·81 μmol/l) with prevalence of deficiency >50 % across all ages. In conclusion, without inflammation adjustment, Fe deficiency was grossly under-estimated and vitamin A and Zn deficiency over-estimated, highlighting the importance of correcting for the influence of such, before implementing programmes to alleviate micronutrient malnutrition. However, further work is needed to validate the proposed approaches with a particular focus on assessing the influence of varying degrees of inflammation (i.e. recurrent acute infections and low-grade chronic inflammation) on each affected nutrient biomarker.
Background: Approximately 12-15% of patients with intracranial aneurysms (IA) have affected first-degree relatives, and are considered to have familial intracranial aneurysms (FIA). Individuals with FIA are at higher risk for aneurysm formation and subarachnoid hemorrhage. THSD1 is the only gene to be associated with nonsyndromic FIA at this time. Our study aims to find rare DNA variants that are major risk factors for FIA in our cohort of patients. Methods: To date we have enrolled 37 affected and 31 unaffected people from 16 families. We have done exome or genome sequencing on at least 1 person from each of 12 families. Results: A rare p.(R686W) variant in THSD1 was found in 1/12 families, but did not cosegregate fully with disease. While less attractive as the primary cause of FIA, we cannot rule out the potential modifying effects of THSD1 p.(R686W) in this family. A second candidate, an extracellular matrix gene within a chromosomal region previously implicated by familial mapping studies, contains rare variants in 4/12 of our families. All four variants are predicted to be damaging. Conclusions: Alongside environmental risk factors, individual FIA families may also have complex rare variant contributions to their disease, such as digenic and multi-locus contributions.