Single center experience on dosing and adverse events of recombinant factor seven use for bleeding after congenital heart surgery

There are limited data on the relationship between the administered dose of recombinant factor seven (rFVIIa) and the development of adverse clinical outcomes after congenital heart surgery. This single institution case series reports on dosing, adverse events, and blood product usage after the administration of rFVIIa in the congenital heart surgery patient population. A retrospective review identified 16 consecutive pediatric patients at an academic, free-standing, children’s hospital who received rFVIIa to curtail bleeding following congenital heart surgery between April 2004 and June 2012. Patients were assessed for survival to hospital discharge versus in-hospital mortality and the presence or absence of a major neurological event during inpatient hospitalization. The median age at surgery was 6.8 months (range: 3 days–42 years). Seven patients (44%) survived to hospital discharge and nine patients (56%) died. The cause of mortality included major neurological events (44%), uncontrolled bleeding (33%), and sepsis (23%). Eight patients (50%) required extracorporeal membrane oxygenation support following congenital heart surgery. The median cumulative rFVIIa dose administered was 97 mcg/kg, and the median cumulative amount of blood products administered was 452 ml/kg. In conclusion, this case series underscores the need to prospectively evaluate the effect that rFVIIa has on patient survival and the incidence of adverse events, including thrombotic and major neurological events, in congenital heart surgery patients. Ideally, a randomized, multicenter study would provide the sufficient numbers of patients and events to test these relationships

Intermediate-Term Results of Extracorporeal Membrane Oxygenation Support Following Congenital Heart Surgery

Background: Although there are considerable data regarding in-hospital results of congenital heart surgery patients requiring post-operative extracorporeal membrane oxygenation support, there is limited information on intermediate-term outcomes. Methods: A single institution retrospective review of 25 consecutive post-operative congenital heart surgery patients who required extracorporeal membrane oxygenation and survived to hospital discharge between January 2003 and June 2008. Survival was estimated by the Kaplan-Meier method. Results: At a median follow-up of 3.3 years (interquartile range: 1.2-5.9 years), there was 1 death which occurred at 6 months post-surgery. Kaplan-Meier estimated survival at 3 years was 95% (95% confidence interval: 90-100%). Indications for extracorporeal membrane oxygenation included extracorporeal cardiopulmonary resuscitation (48%), systemic hypoxia (4%), post-operative low cardiac output syndrome (28%), and intra-operative failure to wean off of cardiopulmonary bypass (20%). Following extracorporeal membrane oxygenation support, 65% of patients had unplanned cardiac re-interventions (3 requiring operative interventions, 6 requiring percutaneous interventions, and 4 requiring both), and 47% required unplanned hospitalizations. 29% developed neurological deficits, and 12% developed chronic respiratory failure. No patients developed renal failure. Overall systemic ventricular function normalized in 83% of patients, whereas 17% had persistent mild-to-moderate systemic ventricular dysfunction. Conclusions: Intermediate-term patient survival of extracorporeal membrane oxygenation following congenital heart surgery is encouraging. However, neurological impairment and unplanned cardiac re-interventions remain significant concerns. Further delineation of risk factors to improve patient outcomes is warranted

Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience.

OBJECTIVE: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition. DESIGN: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus. RESULTS: The incidence of post-operative vocal cord paralysis was 1.1% (32 out of 3036 patients; 95% confidence interval: 0.7-1.5%). The majority were left-sided injuries (71%). Overall rate of recovery was 61% with a median time of 10 months in those who recovered, and a total follow up of 46 months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation (median 10 vs. 5 days, p = 0.03), ICU length of stay (50 vs. 8 days, p = 0.002), and hospital length of stay (92 vs. 41 days, p = 0.01). No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement. CONCLUSION: Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery

Cooperative Breeding Effects Among the Matrilineal Khasi of N. E. India

As a hallmark of our species, mothers of small children generally require and receive help from others in their reproductive efforts of parenting, in what can be called cooperative breeding. This help appears to affect the frequency of births and the success of reproductive efforts as measured by the health and survival of children. The nature of such effects in family systems organized around women and in which women control resources holds interest with respect to the evolution of the human species. The matrilineal Khasi tribe of N. E. India are swidden agriculturalists characterized by low socioeconomic resources and high natural fertility (average is 6.7 children). Women are economically active in the fields, markets, and in home ownership. Khasi households, which may have several married or single women and men are organized around the matriline, often consisting of three generations. A woman is free to choose her own husband who may or may not join the household. Our data represent 773 households providing lineage and reproductive histories comprising 3,274 births. Dependent variables include interbirth interval, cumulative net reproductive success by age of mother, and child nutritional status and mortality (172 deaths). Within this strongly matrilineal context, we examine measures of reproductive success in terms of local resource enhancement and resource competition models with respect to sibling and older offspring effects (depending on sex, age and birth order). We also examine the effect of husband’s presence and of grandmother’s help at the birth of a child, and her continued presence in the household

Bayesian estimation of fertility rates under imperfect age reporting

This article outlines the application of the Bayesian method of parameter estimation to situations where the probability of age misreporting is high, leading to transfers of an individual from one age group to another. An essential requirement for Bayesian estimation is prior distribution, derived for both perfect and imperfect age reporting. As an alternative to the Bayesian methodology, a classical estimator based on the maximum likelihood principle has also been discussed. Here, the age misreporting probability matrix has been constructed using a performance indicator, which incorporates the relative performance of estimators based on age when reported correctly instead of misreporting. The initial guess of performance indicators can either be empirically or theoretically derived. The method has been illustrated by using data on Empowered Action Group (EAG) states of India from National Family Health Survey-3 (2005-2006) to estimate the total marital fertility rates. The present study reveals through both a simulation and real-life set-up that the Bayesian estimation method has been more promising and reliable in estimating fertility rates, even in situations where age misreporting is higher than in case of classical maximum likelihood estimates

Inverse analysis and multi-objective optimization of coupling mechanism based laser forming process

Laser forming of non-developable surfaces necessitates simultaneous bending and shrinkage of the sheet blank. This can be obtained by coupling mechanism based laser forming. However, soft computing based modeling of this process as well as different laser parameter sets under coupling mechanism giving different optimum combinations of simultaneous bending and shrinkage is rarely reported. In this work, experiments have been carried out following a design of experiments with considered suitable ranges of the input factors, i.e., laser power, travel speed and laser beam diameter activating coupling mechanism. Response surface models for the outputs namely bending and thickening (resulted due to shrinkage) were developed in terms of the considered inputs and parametric effects were analyzed. Finite element modeling was also carried out to analyze the deformation behavior. Multi-objective optimization of laser parameters for different combinations of maximum/minimum of bending and thickening of the sheet material undergoing coupling mechanism has been shown. Forward and inverse models of the process have been built with the help of a backpropagation neural network (BPNN) and genetic algorithm-based neural network (GANN) based on experimental data. Because of the ability of genetic algorithm (GA) to obtain global search, GANN models provide better estimation of the input parameters for inverse modeling or process synthesis compared to that by the BPNN model. Finally, several dome-shaped surfaces were built with constant line energy but different Fourier numbers and hence, different proportions of bending and shrinkage. This was to demonstrate the importance of simultaneous bending and thickening of the sheet (achievable only by coupling mechanism) to generate such non-developable surface with minimal distortion