Arterial Recanalization for Access for Arterial Intervention in Children: Techniques and Outcomes

PURPOSE: To assess technical success of arterial recanalization in children requiring repeated arterial access and intervention. MATERIALS AND METHODS: Over 14 years, 41 attempts to cross 30 arterial occlusions were made in 22 patients (13 male, 9 female). Median patient age was 12 months (15 days-14 years), and weight was 7.6 kg (3.0-77.3 kg). Techniques and outcomes were recorded. RESULTS: Twenty-five of 41 (61%) attempts at crossing an arterial occlusion were successful. Nineteen of 30 (63%) first attempts to cross occlusions were successful, and 6 of 11 (55%) repeat attempts were successful. The occluded segments were combinations of common femoral artery (n = 4), external iliac artery (n = 36), common iliac artery (n = 11), and aorta (n = 1). Complications occurred in 5 of 41(12%) attempts: 3 minor complications (hematoma, extravasation, and transient leg ischemia) and 2 major complications (rupture and thrombosis). CONCLUSIONS: Arterial access by recanalization of occluded segments is technically feasible in children, with a low complication rate

Interactional positioning and narrative self-construction in the first session of psychodynamic-interpersonal psychotherapy

The purpose of this study is to identify possible session one indicators of end of treatment psychotherapy outcome using the framework of three types of interactional positioning; client’s self-positioning, client’s positioning between narrated self and different partners, and the positioning between client and therapist. Three successful cases of 8-session psychodynamic-interpersonal (PI) therapy were selected on the basis of client Beck Depression Inventory scores. One unsuccessful case was also selected against which identified patterns could be tested. The successful clients were more descriptive about their problems and demonstrated active rapport-building, while the therapist used positionings expressed by the client in order to explore the positionings developed between them during therapy. The unsuccessful case was characterized by lack of positive self-comment, minimization of agentic self-capacity, and empathy-disrupting narrative confusions. We conclude that the theory of interactional positioning has been useful in identifying patterns worth exploring as early indicators of success in PI therapy

Cross-sectional study of a UK cohort of neonatal vein of Galen malformation

Objective: Describe the course and outcomes in a UK national cohort of neonates with vein of Galen malformation (VGM) identified before 28 days of life. // Methods: Neonates with angiographically confirmed vein of Galen malformation presenting to one of the two UK treatment centres (2006‐2016) were included; those surviving were invited to participate in neurocognitive assessment. Results in each domain were dichotomised into “good” and “poor” categories. Cross‐sectional and angiographic brain imaging studies were systematically interrogated. Logistic regression was used to explore potential outcome predictors. // Results: Of 85 children with neonatal vein of Galen malformation, 51 had survived. Thirty‐four participated in neurocognitive assessment. Outcomes were approximately evenly split between “good” and “poor” categories across all domains, namely neurological status, general cognition, neuromotor skills, adaptive behaviour, and emotional and behavioural development. Important predictors of poor cognitive outcome were initial Bicetre score </=12 and presence of brain injury, specifically white matter injury, on initial imaging; in multivariable analysis only Bicetre score </=12 remained significant. // Interpretation: Despite modern supportive and endovascular treatment, over a third of unselected newborns with vein of Galen malformation did not survive. Outcome was good in around half of survivors. The importance of white matter injury suggests that abnormalities of venous, as well as arterial, circulation are important in pathophysiology of brain injury

New Lower Bounds on the Self-Avoiding-Walk Connective Constant

We give an elementary new method for obtaining rigorous lower bounds on the connective constant for self-avoiding walks on the hypercubic lattice $Z^d$. The method is based on loop erasure and restoration, and does not require exact enumeration data. Our bounds are best for high $d$, and in fact agree with the first four terms of the $1/d$ expansion for the connective constant. The bounds are the best to date for dimensions $d \geq 3$, but do not produce good results in two dimensions. For $d=3,4,5,6$, respectively, our lower bound is within 2.4\%, 0.43\%, 0.12\%, 0.044\% of the value estimated by series extrapolation.Comment: 35 pages, 388480 bytes Postscript, NYU-TH-93/02/0

Presentation, course, and outcome of postneonatal presentations of vein of Galen malformation: a large, single-institution case series

AIM: To describe presentation, clinical course, and outcome in postneonatal presentations of vein of Galen malformation (VGM). METHOD: Children older than 28 days presenting with VGM (from 2006-2016) were included. Notes/scans were reviewed. Outcome was dichotomized into 'good' or 'poor' using the Recovery and Recurrence Questionnaire. Logistic regression was performed to explore relationships between clinico-radiological features and outcome. RESULTS: Thirty-one children (18 males, 13 females) were included, presenting at a median age of 9.6 months (range 1.2mo-11y 7mo), most commonly with macrocrania (n=24) and prominent facial veins (n=9). Seven had evidence of cardiac failure. VGM morphology was choroidal in 19. Hydrocephalus (n=24) and loss of white matter volume (n=15) were the most common imaging abnormalities. Twenty-nine patients underwent glue embolization (median two per child). Angiographic shunt closure was achieved in 21 out of 28 survivors. Three children died of intracranial haemorrhage (1y, 6y, and 30d after embolization). Ten patients underwent neurosurgical procedures; to treat haemorrhage in four, and hydrocephalus in the rest. Outcome was categorized as good in 20 out of 28 survivors, but this was not predictable on the basis of the variables listed above. INTERPRETATION: Postneonatally presenting VGM has distinctive clinico-radiological features, attributable to venous hypertension. Endovascular treatment is associated with good outcomes, but more specific prognostic prediction was not possible within this cohort. WHAT THIS PAPER ADDS: Clinical and radiological features in older children with vein of Galen malformation relate to venous hypertension; Outcome is good in most cases with endovascular therapy; Mortality is low but is related to intracranial haemorrhage

Peer review and the publication process

Aims: To provide an overview of the peer review process, its various types, selection of peer reviewers, the purpose and significance of the peer review with regard to the assessment and management of quality of publications in academic journals. Design: Discussion paper. Methods: This paper draws on information gained from literature on the peer review process and the authors' knowledge and experience of contributing as peer reviewers and editors in the field of health care, including nursing. Results: There are various types of peer review: single blind; double blind; open; and post-publication review. The role of the reviewers in reviewing manuscripts and their contribution to the scientific and academic community remains important

The Standard Model with gravity couplings

In this paper, we examine the coupling of matter fields to gravity within the framework of the Standard Model of particle physics. The coupling is described in terms of Weyl fermions of a definite chirality, and employs only (anti)self-dual or left-handed spin connection fields. It is known from the work of Ashtekar and others that such fields can furnish a complete description of gravity without matter. We show that conditions ensuring the cancellation of perturbative chiral gauge anomalies are not disturbed. We also explore a global anomaly associated with the theory, and argue that its removal requires that the number of fundamental fermions in the theory must be multiples of 16. In addition, we investigate the behavior of the theory under discrete transformations P, C and T; and discuss possible violations of these discrete symmetries, including CPT, in the presence of instantons and the Adler-Bell-Jackiw anomaly.Comment: Extended, and replaced with LaTex file. 25 Page