Downtown Waterville Feasibility Study Waterville, Maine

The Purpose and Need for this project is to: “Revitalize the Downtown to improve the aesthetics, support existing businesses and encourage economic growth, improve pedestrian and bicycle accommodations and provide adequate parking while maintaining vehicular capacity in the overall area.” Contributions and assistance in the completion of the study were provided by the City of Waterville, Colby College, the Maine Department of Transportation, and the General Public

Visualization of the intracavitary blood flow in systemic ventricles of Fontan patients by contrast echocardiography using particle image velocimetry

<p>Abstract</p> <p>Background</p> <p>Flow patterns in univentricular hearts may have clinical value. Therefore, it is our objective to asses and characterize vortex flow patterns with Fontan circulation in comparison with healthy controls.</p> <p>Methods</p> <p>Twenty-three patients (8 Fontan and 15 normal patients) underwent echocardiography with intravenous contrast agent (Sonovue^®) administration. Dedicated software was used to perform particle image velocimetry (PIV) and to visualize intracavitary flow in the systemic ventricles of the patients. Vortex parameters including vortex depth, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also measured.</p> <p>Results</p> <p>The data from this study show that it is feasible to perform particle velocimetry in Fontan patients. Vortex length (VL) was significantly lower (0.51 ± 0.09 vs 0.65 ± 0.12, <it>P </it>= 0.010) and vortex width (VW) (0.32 ± 0.06 vs 0.27 ± 0.04, <it>p </it>= 0.014), vortex pulsation correlation (VPC) (0.26 ± 0.25 vs -0.22 ± 0.87, <it>p </it>= 0.05) were significantly higher in Fontan patients. Sphericity index (SI) (1.66 ± 0.48 vs 2.42 ± 0.62, <it>p </it>= 0.005), relative strength (RS) (0.77 ± 0.33 vs 1.90 ± 0.47, <it>p </it>= 0.0001), vortex relative strength (VRS) (0.18 ± 0.13 vs 0.43 ± 0.14, <it>p </it>= 0.0001) were significantly lower in the Fontan patients group.</p> <p>Conclusions</p> <p>PIV using contrast echocardiography is feasible in Fontan patients. Fontan patients had aberrant flow patterns as compared to normal hearts in terms of position, shape and sphericity of the main vortices. The vortex from the Fontan group was consistently shorter, wider and rounder than in controls. Whether vortex characteristics are related with clinical outcome is subject to further investigation.</p

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Atrial Septal Defect Type Secundum and Eisenmenger Syndrome

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FUELing the Search for Medical Therapies in Late Fontan Failure

The Fontan operation has become the final step in the palliation of many patients with single ventricle disease1. Although outcome has undoubtedly improved over the years, late failure is common and notoriously difficult to treat2, 3. In the face of increasing numbers of young failing Fontan patients with heart transplant as the only, high risk exit strategy, the quest for medical therapies to prevent decline and/or treat Fontan failure has reached a new level of urgency. In this issue of Circulation , Goldberg et al. report on their experience with udenafil, a long-acting phosphodiesterase type 5 inhibitor, in 400 adolescents with a Fontan circulation4. The authors have to be congratulated for completing a long awaited large prospective, multicenter, placebo-controlled trial, which showed a small, non-significant improvement in peak oxygen consumption (primary aim) and multiple significant but limited improvements at the ventilatory anaerobic threshold (secondary aims). Although essentially a nearly negative study, and with the clinical relevance of the changes observed still uncertain, this work nevertheless provides invaluable information for clinical practice and further research.status: publishe

The peculiar challenges of breathing and exercising with a Fontan circulation

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Should we focus on hematocrit or hemoglobin in patients with eisenmenger syndrome?

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