Extracorporeal membrane oxygenation in postcardiotomy patients: Factors influencing outcome

ObjectiveOur objective was to assess the morbidity and mortality in children requiring extracorporeal membrane oxygenator support after cardiac surgery and to determine factors influencing outcome.MethodsBetween January 2003 and June 2008, 58 patients required extracorporeal membrane oxygenator support after cardiac surgery. A retrospective study was performed and factors influencing outcome were determined by logistic regression modeling with the probability of outcome based on a combination of multivariate predictors.ResultsMedian age and weight were 12 days and 3.3 kg, respectively. Thirty-one patients had single ventricle repair and 27 had biventricular repair. Median duration of support with the oxygenator was 6 days. Thirty-nine (67%) patients were successfully weaned off the support, but only 24 (41%) survived to hospital discharge. Chief complications were renal failure (31%), neurologic complications (29%), and sepsis (16%). Multivariable logistic regression analysis identified 10 days or more of extracorporeal membrane oxygenation (odds ratio = 6.1), urine output less than 2 mL · kg−1 · h−1 in first 24 hours (odds ratio = 15), renal failure (odds ratio = 9.4), and pH less than 7.35 after 24 hours of extracorporeal membrane oxygenation (odds ratio = 82) as significant independent factors associated with failure to wean off extracorporeal membrane oxygenation. Factors associated with failure of hospital discharge despite successful decannulation were as follows: extracorporeal membrane oxygenator support time of 10 days or more, red blood cell transfusion of greater than 1000 mL/kg during the entire period of oxygenator support, and sepsis. Patients with single ventricle repair were at higher risk of hospital mortality.ConclusionLonger duration of extracorporeal membrane oxygenator support, low pH and urine output in the first 24 hours, and renal failure are significant factors associated with mortality during extracorporeal membrane oxygenator support. Exposure to high amounts of blood transfusion during extracorporeal oxygenation, extended extracorporeal membrane oxygenator support, and sepsis increase risk of death after successful decannulation

Genome-Wide Search Reveals the Existence of a Limited Number of Thyroid Hormone Receptor Alpha Target Genes in Cerebellar Neurons

Thyroid hormone (T3) has a major influence on cerebellum post-natal development. The major phenotypic landmark of exposure to low levels of T3 during development (hypothyroidism) in the cerebellum is the retarded inward migration of the most numerous cell type, granular neurons. In order to identify the direct genetic regulation exerted by T3 on cerebellar neurons and their precursors, we used microarray RNA hybridization to perform a time course analysis of T3 induced gene expression in primary cultures of cerebellar neuronal cell. These experiments suggest that we identified a small set of genes which are directly regulated, both in vivo and in vitro, during cerebellum post-natal development. These modest changes suggest that T3 does not acts directly on granular neurons and mainly indirectly influences the cellular interactions taking place during development

Deepwater Horizon oil spill exposure and child health: a longitudinal analysis

The BP Deepwater Horizon oil spill (DHOS) created widespread concern about threats to health among residents of the Louisiana Gulf Coast. This study uses data from the Resilient Children, Youth, and Communities study—a longitudinal cohort survey of households with children in DHOS-affected areas of South Louisiana—to consider the effect of DHOS exposure on health trajectories of children, an especially vulnerable population subgroup. Results from latent linear growth curve models show that family DHOS exposure via physical contact and job/income loss both negatively influenced initial child health. However, the effects of physical exposure dissipated over time while the effects of job/income loss persisted. This pattern holds for both general child health and the number of recent physical health problems children had experienced. These findings help to bridge the literature on disaster impacts and resilience/vulnerability, with the literature on socioeconomic status as a fundamental cause of health outcomes over the life course

Adaptation of pancreatic lipase to the amount and nature of dietary lipids in the growing pig

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Scénarios de pénétration des réacteurs à neutrons rapides en vue de limiter la consommation d'uranium naturel cumulée

Dans un contexte de croissance modérée de la demande électrique en France (temps de doublement : cent ans), on montre que les réacteurs à neutrons rapides (RNR) peuvent constituer la relève des réacteurs à eau pressurisée (REP) à partir des années 2000, permettant ainsi de limiter à moins de 450 000 t la consommation en uranium naturel cumulée, sous réserve : — qu'ils soient initialement de bons surgénérateurs ; — que le temps de séjour hors pile soit faible (au plus égal à trois ans). Le recyclage du plutonium dans les REP permet d'éviter des fluctuations importantes du stock de plutonium. Cependant, ce recyclage réduit les quantités de plutonium disponibles. De ce fait, le démarrage des RNR est retardé et les besoins en uranium naturel sont augmentés sensiblement. A court terme, un bon convertisseur est une solution de substitution au « recyclage Pu classique », mais non aux RNR ; à long terme, en symbiose avec les RNR, il permet une bonne gestion des stocks de plutonium. La vitesse de croissance du parc RNR nécessite d'avoir un produit industriel dès l'an 2000