Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Objective: We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. Methods: Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down’s syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%). Results: There were no hospital deaths. Actuarial survival was 96% 3.9% at 5 years and 85.9 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P ¼ .16), nor did the choice to use a valved conduit (P ¼ .82). Primary correction (P ¼ .05) and lower weight at repair (P ¼ .05) were associated with higher probability of survival. Mean follow-up was 69.3 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38%at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P<.05). Conclusions: Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention

The nature of the low-frequency emission of M51: First observations of a nearby galaxy with LOFAR

The grand-design spiral galaxy M51 was observed with the LOFAR High Frequency Antennas (HBA) and imaged in total intensity and polarisation. This observation covered the frequencies between 115 MHz and 175 MHz. We produced an image of total emission of M51 at the mean frequency of 151 MHz with 20 arcsec resolution and 0.3 mJy rms noise, which is the most sensitive image of a galaxy at frequencies below 300 MHz so far. The integrated spectrum of total radio emission is described well by a power law, while flat spectral indices in the central region indicate thermal absorption. We observe that the disk extends out to 16 kpc and see a break in the radial profile near the optical radius of the disk. Our main results, the scale lengths of the inner and outer disks at 151 MHz and 1.4 GHz, arm--interarm contrast, and the break scales of the radio--far-infrared correlations, can be explained consistently by CRE diffusion, leading to a longer propagation length of CRE of lower energy. The distribution of CRE sources drops sharply at about 10 kpc radius, where the star formation rate also decreases sharply. We find evidence that thermal absorption is primarily caused by HII regions. The non-detection of polarisation from M51 at 151 MHz is consistent with the estimates of Faraday depolarisation. Future searches for polarised emission in this frequency range should concentrate on regions with low star formation rates.Comment: 20 pages, 18 figures, accepted for publication in A&

Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Objective: We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. Methods: Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down’s syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%). Results: There were no hospital deaths. Actuarial survival was 96% 3.9% at 5 years and 85.9 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P ¼ .16), nor did the choice to use a valved conduit (P ¼ .82). Primary correction (P ¼ .05) and lower weight at repair (P ¼ .05) were associated with higher probability of survival. Mean follow-up was 69.3 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38%at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P<.05). Conclusions: Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention

Pharmacogenetic analysis of liver toxicity after busulfan/cyclophosphamide-based allogeneic hematopoietic stem cell transplantation

Unlabelled: THE AIM of this study was to evaluate the impact of genomic polymorphisms of methylene-tetrahydrofolate-reductase (MTHFR-C677T, MTHFR-A1298C) and various glutathione S-transferases (GSTP1-Ilel05Val, GSTA1*a/b, GSTM1, GSTT1) on the occurrence of liver toxicity in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Patients and methods: Eighty-four adult patients were enrolled in this retrospective study. All patients were treated with busulfan/cyclophosphamide as a conditioning regimen and received cyclosporine and short-course MTX for GvHD prophylaxis. Genotyping was performed using PCR based restriction-fragment-length-polymorphism (RFLP) techniques. Results: Multivariate analysis identified the MTHFR-A1298C polymorphism as an independent predictor for maximum levels of bilirubin (p=0.0025) and duration of hyperbilirubinaemia (p=0.013). Furthermore, there was an association between this polymorphism and the occurrence of the sinusoidal obstruction syndrome (SOS) (p=0.048). No significant associations between the MTHFR-C677T or the various GST polymorphisms and liver toxicity were observed. Conclusion: The MTHFR-A1298C polymorphism might be associated with liver toxicity in patients receiving allogeneic HSCT

Metastates in mean-field models with random external fields generated by Markov chains

We extend the construction by Kuelske and Iacobelli of metastates in finite-state mean-field models in independent disorder to situations where the local disorder terms are are a sample of an external ergodic Markov chain in equilibrium. We show that for non-degenerate Markov chains, the structure of the theorems is analogous to the case of i.i.d. variables when the limiting weights in the metastate are expressed with the aid of a CLT for the occupation time measure of the chain. As a new phenomenon we also show in a Potts example that, for a degenerate non-reversible chain this CLT approximation is not enough and the metastate can have less symmetry than the symmetry of the interaction and a Gaussian approximation of disorder fluctuations would suggest.Comment: 20 pages, 2 figure

Alcohol And Cannabis Use Among Women With Infertility: Associations With Psychological Distress, Attempts To Conceive, And Engagement In Fertility Treatment

Objective: An infertility diagnosis can lead to distress. Although substance use is common and can also lead to distress, little is known about use among those with an infertility diagnosis. This is important since substance use can have implications for fertility. The purpose of this study was to estimate the rate of alcohol and cannabis use among women with infertility and examine whether substance use had associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatments. Materials and Methods: Patients from one healthcare system were eligible if they received a female infertility diagnosis within the past 2 years. Participants (N=188) completed an online questionnaire on their alcohol use, cannabis use, and psychiatric symptoms. Results: The rates of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with depression or anxiety (p’s\u3e .05). Those with any cannabis use were more likely to have higher depression scores than those without (p= .02). Those with hazardous cannabis use were also more likely to have higher depression scores (p= .001) and higher anxiety scores (p= .03). Substance use was not associated with actively trying to conceive. However, participants pursuing fertility treatments were less likely to engage in hazardous alcohol use (p= .02). Conclusion: Cannabis use was associated with depression and anxiety scores, suggesting that cannabis may be used for coping. Though many women engage in hazardous alcohol or cannabis use, pursuing fertility treatments may serve as a protective factor

A low-frequency view of mixed-morphology supernova remnant VRO 42.05.01, and its neighbourhood

Context. Mixed-morphology supernova remnants (MM SNRs) are a mysterious class of objects that display thermal X-ray emission within their radio shell. They are an older class of SNRs, and as such are profoundly affected by the environment into which they evolve. VRO 42.05.01 is a MM SNR of puzzling morphology in the direction of the Galactic anticentre. Aims. Low-frequency radio observations of supernova remnants are sensitive to synchrotron electrons accelerated in the shock front. We aim to compare the low-frequency emission to higher frequency observations to understand the environmental and shock acceleration conditions that have given rise to the observed properties of this source. Methods. We present a LOFAR High Band Antenna map centred at 143 MHz of the region of the Galactic plane centred at l = 166°, b = 3.5° at 143 MHz, with a resolution of 148" and an rms noise of 4.4 mJy bm−1. Our map is sensitive to scales as large as 6°. We compared the LOw Frequency ARay (LOFAR) observations to archival higher frequency radio, infrared, and optical data to study the emission properties of the source in different spectral regimes. We did this both for the SNR and for OA 184, an H II region within our field of view. Results. We find that the radio spectral index of VRO 42.05.01 increases at low radio frequencies; i.e. the LOFAR flux is higher than expected from the measured spectral index value at higher radio frequencies. This observed curvature in the low-frequency end of the radio spectrum occurs primarily in the brightest regions of the source, while the fainter regions present a roughly constant power-law behaviour between 143 MHz and 2695 MHz. We favour an explanation for this steepening whereby radiative shocks have high compression ratios and electrons of different energies probe different length scales across the shocks, therefore sampling regions of different compression ratios