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We report the midterm results of our strategy utilizing transatrial-transpulmonary repair for tetralogy of Fallot at a single institution in a low-middle income country.
Methods:
Medical records were retrospectively reviewed for 532 consecutive patients who underwent definitive repair of tetralogy of Fallot at our institution from 2010 to 2020.
Results:
The median age and weight of patients in the study patients were 11.6 months (interquartile range, 8.6–17.2 months) and 7.5 kg (interquartile range, 6.8-8.8 kg). The pulmonary valve annulus was preserved (no transannular patch) in 398 patients (75%) and a mini-transannular patch was utilized for 134 patients (25%). The overall survival was 98% at 1 year, and 97% at 10-years follow-up, respectively. Longer postoperative ventilation time was the only risk factor correlated to early death (p = 0.004; Odds Risk, 1.04; 95% confidence intervals, 1.01–1.07). Fourteen patients required pulmonary valve replacement (2.6%, 14/532), four required surgical resection to relieve right ventricular outflow tract obstruction (0.8%, 4/532), and freedom from reoperation of the right ventricular outflow tract was 87% at 10 years. The only risk factor for right ventricular outflow tract reoperation was a postoperative systolic pressure gradient through the right ventricular outflow tract of greater than 50 mmHg (p < 0.001; HR, 47; 95% confidence intervals, 9.1–244). In total, 94.6% (471/489) of the patients were asymptomatic at the latest follow-up without significant arrhythmia.
Conclusion:
At our institution in an low-middle income country, the transatrial-transpulmonary repair for tetralogy of Fallot has excellent midterm results with few reoperations required. Close long-term follow-up is essential for patients who undergo repair with a mini-transannular patch and may eventually require pulmonary valve replacement.
Lutjanus malabaricus represents a widely distributed and intensively exploited snapper species. The present article is the first attempt to describe the life-history traits of L. malabaricus in Vietnamese waters and estimate their variability. The fish were collected at the landing sites of Nghe An and Ha Tinh provinces from June 2020 to May 2021. The standard length of fish ranged from 10 to 74 cm, weight varied between 18.53 and 8972.89 g, age ranged from 1 to 17 years and all three parameters were subjected to a significant seasonal variation. A similar seasonal pattern was observed in the variation of maturity and gonadosomatic index. We assume that the observed variation of the stock structure is the result of spawning migrations when large fish migrate inshore from the foraging grounds. Growth and weight gain of fish were described via the von Bertalanffy function, constants of the equations were as follows: L∞ = 76.2, K = −0.077, t0 = −2.26 in males and L∞ = 56.9, K = −0.176, t0 = −0.48 in females; W∞ = 6498, K = −0.100, t0 = −1.96 in males and W∞ = 8317, K = −0.100, t0 = −1.31 in females. The growth constants of the North Vietnamese stock of L. malabaricus are similar to the ones of the North-eastern Australian stock. A general tendency for the reduction of the growth rate and asymptotic size from equatorial waters to higher latitudes was observed.
The paper describes an ongoing effort in developing a declarative system for supporting operators in the Nuclear Power Plant (NPP) control room. The focus is on two modules: diagnosis and explanation of events that happened in NPPs. We describe an Answer Set Programming (ASP) representation of an NPP, which consists of declarations of state variables, components, their connections, and rules encoding the plant behavior. We then show how the ASP program can be used to explain the series of events that occurred in the Three Mile Island, Unit 2 (TMI-2) NPP accident, the most severe accident in the USA nuclear power plant operating history. We also describe an explanation module aimed at addressing answers to questions such as “why an event occurs?” or “what should be done?” given the collected data.
In situ small-angle x-ray scattering (SAXS) is used to investigate the electrochemical durability of Pt-Metal (Pt-M) catalysts sputtered onto nitrogen-modified high surface area carbon powder. The results demonstrate that nitrogen modification promotes catalyst durability through reduction of nanoparticle dissolution and coarsening. Although particle sizes of Pt-M on high surface area carbon supports can be difficult to determine with transmission electron microscopy (TEM), a novel SAXS method has been employed to calculate particle size. SAXS analysis shows that the Pt-M nanoparticle size distribution remained stable for 3000 electrochemical cycles after nitrogen modification, whereas the unmodified support material leads to Pt-M nanoparticle instabilities. These results for industrial-relevant catalyst/support architectures underscore the potential of nitrogen-modified carbon support structures for enhanced Pt-M catalyst durability.
This work concerns the breakup of millimetre-scale liquid droplets in gaseous flow fields that are disturbed from free-stream conditions by the presence of solid obstacles or other drops. A broad range of flow conditions is considered – from subsonic to supersonic, from highly rarefied to ambient pressures, and from fixed cylindrical obstacles to free liquid droplets (as obstacles). The liquid is water or tributyl phosphate, a water-like low-viscosity fluid of very low vapour pressure. We present data on deformation and breakup regimes, and, aided by numerical simulations, we discuss governing mechanisms and the time scaling of these events. Thereby a methodology is demonstrated for conveniently forecasting first-order behaviours in disturbed flow fields more generally. The highly resolved images lend themselves to testing/benchmarking numerical simulations of interfacial flows. These results, along with the experimental capability developed, constitute one of the key building blocks for our overall long-term aim towards predicting ultimate particle-size distributions from such intense aerodynamic interactions involving very large quantities of Newtonian and viscoelastic liquids.
To evaluate the risk of transmission of SARS coronavirus outside of the health-care setting, close household and community contacts of laboratory-confirmed SARS cases were identified and followed up for clinical and laboratory evidence of SARS infection. Individual- and household-level risk factors for transmission were investigated. Nine persons with serological evidence of SARS infection were identified amongst 212 close contacts of 45 laboratory- confirmed SARS cases (secondary attack rate 4·2%, 95% CI 1·5–7). In this cohort, the average number of secondary infections caused by a single infectious case was 0·2. Two community contacts with laboratory evidence of SARS coronavirus infection had mild or sub-clinical infection, representing 3% (2/65) of Vietnamese SARS cases. There was no evidence of transmission of infection before symptom onset. Physically caring for a symptomatic laboratory-confirmed SARS case was the only independent risk factor for SARS transmission (OR 5·78, 95% CI 1·23–24·24).
Density of states changes in the valence and conduction band of silicon nanoclusters were monitored using soft x-ray emission and absorption spectroscopy as a function of cluster size. A progressive increase in the valence band edge toward lower energy is found for clusters with decreasing diameters. A similar but smaller shift is observed in the near-edge x-ray absorption data of the silicon nanoclusters.
We have studied the near-edge optical response of a LT-grown GaAs sample which was deposited at 300 °C on a Si substrate, and then annealed at 600 °C. The Si was etched away to leave a 3-micron free standing GaAs film. Femtosecond transmission measurements were made using an equal pulse technique at four wavelengths between 825 and 870 nm. For each wavelength we observe both a multipicosecond relaxation time, as well as a shorter relaxation time which is less than 100 femtoseconds.
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