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Arterial oxygen saturation in single ventricle patients is dependent on systemic cardiac output. Here, we describe a case of a newborn with single ventricle physiology and an unusual mechanism to explain poor cardiac output and cyanosis. This case highlights the importance of identifying and considering ventricular morphology and ventricular-ventricular interactions to understand clinical challenges.
This meta-analysis aimed to consolidate existing data from randomised controlled trials on hypoplastic left heart syndrome.
Methods:
Hypoplastic left heart syndrome specific randomised controlled trials published between January 2005 and September 2021 in MEDLINE, EMBASE, and Cochrane databases were included. Regardless of clinical outcomes, we included all randomised controlled trials about hypoplastic left heart syndrome and categorised them according to their results. Two reviewers independently assessed for eligibility, relevance, and data extraction. The primary outcome was mortality after Norwood surgery. Study quality and heterogeneity were assessed. A random-effects model was used for analysis.
Results:
Of the 33 included randomised controlled trials, 21 compared right ventricle-to-pulmonary artery shunt and modified Blalock–Taussig-Thomas shunt during the Norwood procedure, and 12 regarded medication, surgical strategy, cardiopulmonary bypass tactics, and ICU management. Survival rates up to 1 year were superior in the right ventricle-to-pulmonary artery shunt group; this difference began to disappear at 3 years and remained unchanged until 6 years. The right ventricle-to-pulmonary artery shunt group had a significantly higher reintervention rate from the interstage to the 6-year follow-up period. Right ventricular function was better in the modified Blalock–Taussig-Thomas shunt group 1–3 years after the Norwood procedure, but its superiority diminished in the 6-year follow-up. Randomised controlled trials regarding medical treatment, surgical strategy during cardiopulmonary bypass, and ICU management yielded insignificant results.
Conclusions:
Although right ventricle-to-pulmonary artery shunt appeared to be superior in the early period, the two shunts applied during the Norwood procedure demonstrated comparable long-term prognosis despite high reintervention rates in right ventricle-to-pulmonary artery shunt due to pulmonary artery stenosis. For medical/perioperative management of hypoplastic left heart syndrome, further randomised controlled trials are needed to deliver specific evidence-based recommendations.
Alluvial rubies and sapphires are found in palaeodrainage deposits along the Cudgegong-Macquarie River system, central eastern New South Wales, Australia. A pink to red suite contains Cr (up to 0.6 wt.% Cr2O3) as the main chromophore, exceeding Fe (up to 0.5 wt.%Fe2O3). Corrosive etching suggests a prior xenocrystic Mesozoic-Cenozoic basaltic transport, while Cr2O3/Ga2O3 to Fe2O3/TiO2 ratios indicate an original metamorphic source. Syngenetic mineral inclusions include Al-rich diopside, meionite and anatase. The Al-rich diopside (‘fassaite’) contains extremely high Al2O3 (20–21 wt.%). A blue-green suite contains Fe (up to 0.8 wt.% Fe2O3) as a dominant chromophore, while a rare nepheline-anorthoclase composite inclusion supports a magmatic phonolitic origin. The Cudgegong- Macquarie ruby formation is compared with a garnet granulite origin proposed for Thailand rubies and a xenolith of corundum-bearing garnet granulite from Ruby Hill, Bingara, Australia. Clinopyroxenecorundum thermometry suggests the Cudgegong-Macquarie rubies formed at T >1000–1300ºC, a high equilibration T for proposed lithospheric granulites. These rubies form a distinctive suite compared to other rubies from Australian and SE Asian basalt fields, but have some similarities with eastern Thailand rubies.
To describe the epidemiology of bloodstream infection caused by USA300 strains of methicillin-resistant Staphylococcus aureus (MRSA), which are traditionally associated with cases of community-acquired infection, in the healthcare setting.
Design.
Retrospective cohort study.
Setting.
Three academically affiliated hospitals in Denver, Colorado.
Methods.
Review of cases of S. aureus bloodstream infection during the period from 2003 through 2007. Polymerase chain reaction was used to identify MRSA USA300 isolates.
Results.
A total of 330 cases of MRSA bloodstream infection occurred during the study period, of which 286 (87%) were healthcare-associated. The rates of methicillin resistance among the S. aureus isolates recovered did not vary during the study period and were similar among the 3 hospitals. However, the percentages of cases of healthcare-associated MRSA bloodstream infection due to USA300 strains varied substantially among the 3 hospitals: 62%, 19%, and 36% (P < .001) for community-onset cases and 33%, 3%, and 33% (P = .005) for hospital-onset cases, in hospitals A, B, and C, respectively. In addition, the number of cases of healthcare-associated MRSA bloodstream infection caused by USA300 strains increased during the study period at 2 of the 3 hospitals. At each hospital, USA300 strains were most common among cases of community-associated infection and were least common among cases of hospital-onset infection. Admission to hospital A (a safety-net hospital), injection drug use, and human immunodeficiency virus infection were independent risk factors for healthcare-associated MRSA bloodstream infection due to USA300 strains.
Conclusions.
The prevalence of USA300 strains among cases of healthcare-associated MRSA bloodstream infection varied dramatically among geographically clustered hospitals. USA300 strains are replacing traditional healthcare-related strains of MRSA in some healthcare settings. Our data suggest that the prevalence of USA300 strains in the community is the dominant factor affecting the prevalence of this strain type in the healthcare setting.
A new model for the provenance, depositional environment and tectonic setting of the Northern Belt of the Southern Uplands is presented. This turbiditic sandstone-dominated sequence was deposited in a sand-rich submarine fan environment, overlying sparse hemipelagic mudstones. The oldest sandstones are rich in juvenile ophiolitic material and record the first clastic input into the Southern Uplands basin. The bulk of the Northern Belt sedimentary sequence, however, is dominated by relatively quartzose sandstones derived from a Proterozoic continental/metamorphic source represented by the Midland Valley terrane of Scotland and Ireland. The quartzose-dominated succession was punctuated by the input of fresh volcanic detritus shed from an oceanic/continental island-arc situated to the W/NW of the Northern Belt basin, with sediment dispersal turning to the NE along the axis of the basin in Scotland. The tectonic setting of the Northern Belt basin remains uncertain. The complex provenance of the sandstones and recognition of major olistostrome units within the Northern Belt succession suggest that it was tectonically active. The onset of clastic deposition within the Southern Uplands terrane broadly corresponds to uplift and erosion of earlier obducted ophiolite in both Scotland and Ireland, possibly in response to collision of Cambrian–early Ordovician island-arc systems with the Laurentian continental margin. If this interpretation is correct, then the possibility arises that the Southern Uplands–Midland Valley terranes record the dismembering of this oceanic/continental island-arc complex within an overall transpressional regime.
Controversy persists over the efficacy of intercostal nerve block administered through a tunnelled extrapleural catheter. We have undertaken a randomized, prospective double-blind trial of two different local anaesthetic regimes to evaluate the effect of this technique on post-thoracotomy pain relief and pulmonary function. Sixty-eight patients were randomized to receive bupivacaine 0.25% (n=22), lignocaine 1% (n=21) or 0.9% NaCl (saline) (n=20) via an extrapleural catheter, inserted peroperatively. All patients underwent a standard posterolateral thoracotomy. Pain was assessed using a visual analogue pain score and by the requirement for opiate analgesia. Pulmonary function was measured using bedside spirometry. Pain scores were lower in the local anaesthetic groups at 24, 32 and 72 h compared with placebo (P< 0.05) and the total amount of opiate required was less than placebo for both lignocaine and bupivicaine (P< 0.05). Pulmonary function was better in the local anaesthetic groups throughout the post-operative period and was most pronounced at 24 h with a mean improvement of 30% for forced expiratory volume (FEV1), 24% for forced vital capacity (FVC) and 19% for peak expiratory flow rate (PEFR) compared with placebo. There was no significant difference between pain scores, opiate requirement or pulmonary function between lignocaine and bupivicaine. CT scanning demonstrated containment of the local anaesthetic in an extra-pleural tunnel. Extra-pleural infusion of local anaesthetics is a simple technique, with low risk of complications and provides effective pain relief as well as an improvement in post-operative pulmonary function. Lignocaine is equally as effective as bupivacaine and its use would result in some cost-saving.
Chemical vapor deposition from (MeCp)2Nb(allyl) at atmospheric pressure yields niobium carbide films at temperatures as low as 300°C. X-ray photoelectron spectroscopy (XPS) studies indicate that the bulk films contain a carbide phase and a nearly stoichiometric ratio of niobium to carbon. The morphology of the films has been examined by scanning electron microscopy (SEM).
This study examines a series of elderly admissions to a psychiatric hospital and a geriatric hospital serving the same catchment area in order to evaluate the success of the two hospital services in separating their patients into two groups, and to study the effect, if any, on the prognosis of those patients who were ‘incorrectly labelled’.
The original aim of the U.S./U.K. Diagnostic Project, founded in 1965, was to examine differences in the national statistics for the diagnostic frequencies among patients admitted to state mental hospitals in the United States of America and to area mental hospitals in England and Wales.
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