5 results
N-terminal pro-B-type-natriuretic peptide as a screening tool for pulmonary hypertension in the paediatric population
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- Soham Dasgupta, Erika Bettermann, Michael Kelleman, Usama Kanaan, Ritu Sachdeva, Christopher Petit, Dennis Kim, Robert Vincent, Holly Bauser-Heaton
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- Journal:
- Cardiology in the Young / Volume 31 / Issue 10 / October 2021
- Published online by Cambridge University Press:
- 02 March 2021, pp. 1595-1607
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Background:
Although cardiac catheterisation (cath) is the diagnostic test for pulmonary hypertension, it is an invasive procedure. Echocardiography (echo) is commonly used for the non-invasive diagnosis of pulmonary hypertension but maybe limited by lack of adequate signals. Therefore, emphasis has been placed on biomarkers as a potential diagnostic tool. No prior paediatric studies have simultaneously compared N-terminal pro-B-type-natriuretic peptide (NTproBNP) with cath/echo as a potential diagnostic tool. The aim of this study was to determine if NTproBNP was a reliable diagnostic tool for pulmonary hypertension in this population.
Methods:Patients were divided into Study (echo evidence/established diagnosis of pulmonary hypertension undergoing cath) and Control (cath for small atrial septal defect/patent ductus arteriosus and endomyocardial biopsy post cardiac transplant) groups. NTproBNP, cath/echo data were obtained.
Results:Thirty-one patients met inclusion criteria (10 Study, 21 Control). Median NTproBNP was significantly higher in the Study group. Echo parameters including transannular plane systolic excursion z scores, pulmonary artery acceleration time and right ventricular fractional area change were lower in the Study group and correlated negatively with NTproBNP. Receiver operation characteristic curve analysis demonstrated NTproBNP > 389 pg/ml was 87% specific for the diagnosis of pulmonary hypertension with the addition of pulmonary artery acceleration time improving the specificity.
Conclusions:NTproBNP may be a valuable adjunctive diagnostic tool for pulmonary hypertension in the paediatric population. Echo measures of transannular plane systolic excursion z score, pulmonary artery acceleration time and right ventricular fractional area change had negative correlations with NTproBNP. The utility of NTproBNP as a screening tool for pulmonary hypertension requires validation in a population with unknown pulmonary hypertension status.
Thromboprophylaxis strategies for children with single-ventricle circulations (superior or total cavo-pulmonary connections) after stent implantation
- Yinn K. Ooi, R. Allen Ligon, Michael Kelleman, Robert N. Vincent, Holly D. Bauser-Heaton, Dennis W. Kim, Christopher J. Petit
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- Journal:
- Cardiology in the Young / Volume 29 / Issue 7 / July 2019
- Published online by Cambridge University Press:
- 18 June 2019, pp. 877-884
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Objective:
To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections.
Background:Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients.
Methods:All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included. Cohort was divided into aspirin therapy alone versus advanced anticoagulation, including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was in-stent or downstream thrombus, and secondary endpoints included bleeding complications.
Results:A total of 58 patients with single-ventricle circulation underwent 72 stent implantations. Of them 14 stents (19%) were implanted post-superior cavopulmonary connection and 58 (81%) post-total cavopulmonary connection. Indications for stenting included vessel/conduit stenosis (67%), external compression (18%), and thrombotic occlusion (15%). Advanced anticoagulation was prescribed for 32 (44%) patients and aspirin for 40 (56%) patients. Median follow up was 1.1 (25th–75th percentile, 0.5–2.6) years. Echocardiograms were available in 71 patients (99%), and advanced imaging in 44 patients (61%). Thrombosis was present in two patients on advanced anticoagulation (6.3%) and none noted in patients on aspirin (p = 0.187). Both patients with in-stent thrombus underwent initial stenting due to occlusive left pulmonary artery thrombus acutely post-superior cavopulmonary connection. There were seven (22%) significant bleeding complications for advanced anticoagulation and none for aspirin (p < 0.001).
Conclusions:Antithrombotic strategy does not appear to affect rates of in-stent thrombus in single-ventricle circulations. Aspirin alone may be sufficient for most patients undergoing stent implantation, while pre-existing thrombus may warrant advanced anticoagulation.
Crow instability: nonlinear response to the linear optimal perturbation
- Holly G. Johnson, Vincent Brion, Laurent Jacquin
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- Journal:
- Journal of Fluid Mechanics / Volume 795 / 25 May 2016
- Published online by Cambridge University Press:
- 19 April 2016, pp. 652-670
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The potential for anticipated destruction of a counter-rotating vortex pair using the linear optimal perturbation of the Crow instability is assessed. Direct numerical simulation is used to study the development of the Crow instability and the subsequent evolution of the flow up to 30 characteristic times at a circulation-based Reynolds number of 1000. The conventional development of the instability leads to multiple contortions of the vortices including the linear growth of sinusoidal deformation, vortex linking and the formation of vortex rings. A new evolution stage is identified, succeeding this well-established sequence: the vortex rings undergo periodic oscillation. Two complete periods are simulated during which the vortical system is hardly altered, thereby demonstrating the extraordinary resilience of the vortices. The possibility of preventing these dynamics using the linear optimal perturbation of the Crow instability, the adjoint mode, is analysed. By appropriately setting the forcing amplitude, the lifetime of the vortices until their loss of coherence is reduced to approximately 13 characteristic times, which is less than half that of the natural Crow behaviour observed with infinitesimal forcing. The dynamics of the flow induced by the linear optimal perturbation that enable this result are connected to processes already known to efficiently alter vortical flows, in particular transient growth and four-vortex dynamics.
Genetic gap analysis of wild Hordeum taxa
- Holly Vincent, Roland von Bothmer, Helmut Knüpffer, Ahmed Amri, Jan Konopka, Nigel Maxted
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- Journal:
- Plant Genetic Resources / Volume 10 / Issue 3 / December 2012
- Published online by Cambridge University Press:
- 30 October 2012, pp. 242-253
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To facilitate the updating of in situ and ex situ conservation strategies for wild taxa of the genus Hordeum L., a combined ecogeographic survey and gap analysis was undertaken. The analysis was based on the Global Inventory of Barley Plant Genetic Resources held by ICARDA plus additional datasets, resulting in a database containing 17,131 wild Hordeum accessions. The analysis concluded that a genetic reserve should be established in the Mendoza Province of Argentina, as this is the most species-rich area globally for Hordeum. A network of reserves should also be set up across the Fertile Crescent in Israel, Palestine, Syria, Jordan, Lebanon and Turkey to provide effective conservation within the centres of diversity for gene pools 1B (Hordeum vulgare subsp. spontaneum (C. Koch) Thell.) and 2 (Hordeum bulbosum L.). The majority of the species were deemed under-collected, so further collecting missions are required worldwide where possible. Although ex situ and in situ conservation strategies have been developed, there needs to be further investigation into the ecological environments that Hordeum species occupy to ensure that any adaptive traits expressed are fully conserved. Additionally, studies are required to characterize existing collections and test the viability of rare species accessions held in genebanks to determine whether further ex situ collections are required alongside the proposed in situ conservation.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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