Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants

Background: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. Methods: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. Results: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). Conclusions: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery

Molecular simulation of CO2 adsorption in the presence of water in single-walled carbon nanotubes

The adsorption of carbon dioxide in the presence of water in single-walled carbon nanotubes is studied using Monte Carlo simulation, at 300, 325, and 350 K. We also investigate the influence of the diameter and chirality of the nanotubes on the adsorption isotherms of CO2. It is observed that increasing the nanotube diameter from 1.36 nm (10, 10) to 2.03 nm (15, 15) leads to enhanced CO2 capacity, while change in chirality has little effect on the adsorption capacity of carbon nanotubes. Our results show that the influence of preadsorbed water on CO2 adsorption is dependent on both the effects of excluded volume and H2O-CO2 interactions. The maximum adsorbed amount of CO2 decreases linearly with the loading of water, and drops more rapidly in narrower nanotubes. The structure of water in hydrophobic nanopores is in the form of hydrogen-bonded clusters, and its adsorption does not affect the arrangement and orientation of CO2 molecules (i.e., it does not affect the mechanism of CO2 adsorption). The average size of water clusters coexisting with CO2 depends strongly on the adsorbed amount of CO2; however, it is shown that splitting large water clusters into smaller ones can lead to significant enhancement of CO2 adsorption, due to the resulting stronger water-CO2 interaction. The maximum percentage increase in the excess adsorption of CO2 is as high as 53.4% when a single cluster is split into multiple smaller clusters. This finding demonstrates that the efficiency of CO2 capture from flue gas can be significantly improved by controlling the structure of coexisting water in carbon nanotubes

Trattato di Diritto dell'Ambiente - Vol. II: I procedimenti Amministrativi per la tutela dell'ambiente - Capitolo 10: L'accertamento del danno ambientale

Il Trattato si compone di tre volumi, con i quali si d\ue0 conto in modo pressoch\ue9 completo dell'evoluzione del diritto dell'ambiente, della sua collocazione nell'ordinamento giuridico generale e delle normative di settore che ne costituiscono il corpo disciplinare. Alla luce di ci\uf2, l'approccio dei singoli contributi di ognuno dei tre volumi del Trattato vuole essere eminentemente pratico, senza tuttavia rinunciare ad una pi\uf9 generale e sistematica riflessione intorno alla problematiche che vengono affrontate. E pour cause, verrebbe da ribadire, poich\ue9 il diritto dell'ambiente intercetta s\uec problemi, ed anche bisogni ed emergenze, a carattere concreto ma svolge, altres\uec, una funzione maieutica delineando soluzioni utili ed efficaci per molti problemi, anche al di fuori (oppure oltre) i confini della materia strettamente ambientale