Status of the left ventricle after arterial switch operation for transposition of the great arteries Hemodynamic and echocardiographic evaluation

AbstractBackground : The potential for improved preservation of systemic ventricular function represents an important reason for the increasing popularity of the arterial switch operation. In support of this expectation, prior studies in patients early after arterial switch operation have found normal ventricular contractility and function. This study was conducted to extend those observations to up to 10 years of follow-up and to directly examine the effects of a coexisting ventricular septal defect or short-term preparatory banding of the pulmonary artery before the arterial switch operation. Methods : Patients operated on from 1983 through 1991 were included. Echocardiographic and catheterization data were collected as part of a prospective evaluation of outcome in all patients who undergo the arterial switch operation at Boston Children's Hospital, with inclusion of data from the most recent catheterization only. Echocardiograms performed at least 6 months after the operation were included, with assessment of both the most recent status as well as serial trends. Whenever possible, echocardiographic evaluation included data necessary to perform analysis of ventricular mechanics including indices of afterload, preload, and contractility. Comparison was made to normal values and between subgroups defined on the basis of an arterial switch operation with or without ventricular septal defect and those who had a rapid two-stage arterial switch operation. Results : Invasive measures of left and right ventricular filling pressures, cardiac index, and pulmonary vascular resistance did not differ among the three groups. Overall, echocardiographic left ventricular end-diastolic dimension, wall thickness, mass, afterload (end-systolic wall stress), function (fractional shortening and rate-corrected velocity of fiber shortening), contractility (stress-velocity and stress-shortening relations), and preload were normal, and none of these variables was different between the groups with and without a ventricular septal defect. Serial evaluation indicated a slight but significant trend toward ventricular dilatation, perhaps related to a relatively high incidence of at least mild aortic regurgitation (30%). In contrast, in the rapid two-stage group the echocardiographic indices of left ventricular function (fractional shortening and velocity of fiber shortening) and contractility (stress-velocity and stress-shortening relations) were found to be mildly but significantly reduced compared with normal subjects and with the other arterial switch operation groups. Over the duration of follow-up encompased by this study, no tendency toward progressive depression of function was seen. Conclusions : As the length of observation after the arterial switch operation continues to increase, left ventricular size, mass, functional status, and contractility continues to be normal, with no evidence of time-related deterioration of function. As previously reported, the rapid two-stage arterial switch operation does represent a higher risk for mild impairment of myocardial mechanics. (J T horac C ardiovasc S urg 1995;109:311-21

Short-term effect of monocuspid valves on pulmonary insufficiency and clinical outcome after surgical repair of tetralogy of fallot

AbstractIn the surgical repair of tetralogy of Fallot, monocuspid valves are sometimes inserted within a transannular patch to prevent pulmonary insufficiency. To determine whether this monocuspid valve prevents short-term postoperative pulmonary insufficiency and improves clinical outcome, we reviewed clinical data and preoperative and postoperative echocardiographic variables from 61 patients who underwent one of three different procedures for repair of tetralogy of Fallot between August 1992 and March 1994. We compared features from 24 patients who had undergone transannular patch repair with a monocuspid valve (patch-valve) with those from 17 patients who had undergone patch repair without a monocuspid valve (patch) and 20 patients who had undergone repair without a transannular patch (no patch). We used the ratio of pulmonary valve insufficiency jet width to pulmonary artery diameter, as measured by color-flow Doppler flowmetry, as an index of severity of pulmonary insufficiency. Moderate to severe pulmonary insufficiency was arbitrarily defined as a ratio of at least 0.50. We found no significant differences in ratios among the patch-valve group (0.73 ± 0.25, mean ± standard deviation), the patch group (0.79 ± 0.20), and the no patch group (0.59 ± 0.23). The percentages of patients with moderate to severe pulmonary insufficiency did not differ among the three groups (patch-valve 80%, patch 90%, no patch 64%). Clinical data (including mortality, number of reoperations, intensive care unit and hospital lengths of stay, and postoperative hemodynamics) were similar in the three groups. We conclude that insertion of a monocuspid valve in repair of tetralogy of Fallot does not prevent short-term postoperative pulmonary insufficiency and does not improve immediate postoperative outcome for these patients. (J Thorac Cardiovasc Surg 1996;112:33-7

La place de l'homéopathie dans les pathologies anxieuses

De nos jours, l anxiété et le stress sont deux pathologies de plus en plus rencontrées dans la population générale. Elles peuvent revêtir de multiples formes cliniques telles que le trouble anxieux généralisé, l attaque de panique ou encore la phobie spécifique. Derrière ces pathologies, se cache un vaste champ thérapeutique. Plus communément, c est le traitement anxiolytique qui prône sur les autres thérapeutiques, et plus précisément l emploi de benzodiazépines. Or, il n est pas sans savoir que ces molécules ne sont pas anodines. De nombreux effets indésirables comme la sédation, la tolérance ou encore la dépendance émergent de l utilisation de ces médicaments. C est pourquoi, il est important que le pharmacien développe ses compétences dans l usage des thérapeutiques alternatives. Parmi celles-ci, il y a l homéopathie. L homéopathie, créée par le médecin Samuel Hahnemann, est une médecine complexe prenant de plus en plus d ampleur auprès des professionnels de santé et du grand public. En s appuyant sur des études cliniques, elle se révèle être une excellente thérapeutique des troubles anxieux.Nowadays anxiety and stress disorders are two pathologies that are found more and more often throughout the general population. They can take multiple clinical forms such as generalized anxiety disorder (GAD), panic disorder or even a specific phobia. Behind these pathologies there is a vast, hidden therapeutic field. The anxiolytic treatment is the most commonly recommended, and more precisely, the use of benzodiazepines. Nevertheless, their molecules are not harmless. Numerous and undesirable effects such as sedation, tolerance and physical dependency can occur after the use of these medicine. That is why, it is important that pharmacists develop their expertise on the use of alternative therapies. Among these therapies is homeopathy. Homeopathy, which was created by the German physician Samuel Hahnemann, is a complex medicine, and the use of it by health professionals and the general public is growing is size. Based on clinical studies, homeopathy has revealed itself as an excellent therapy for anxiety disorders.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Subaortic stenosis in the spectrum of atrioventricular septal defects Solutions may be complex and palliative

AbstractFrom July 1982 through September 1994, 19 children had operative treatment of subaortic stenosis associated with an atrioventricular septal defect. Specific diagnosis were septum primum defects in 7, Rastelli type A defects in 6, transitional defects in 4, inlet ventricular septal defect with malattached chordae in 1, and tetralogy of Fallot with Rastelli type C defect in 1. Twenty-seven operations for subaortic stenosis were performed. Surgical treatment of the outlet lesion was performed at initial atrioventricular septal defect repair in 3 children and in the remaining 16 from 1.2 to 13.1 years (mean 4.9 years, median 3.9 years) after repair. Eighteen of the 19 children had fibrous resection and myectomy for relief of obstruction. Seven children had an associated left atrioventricular valve procedure. One child received an apicoaortic conduit. Seven children (36.8%) required 8 reoperations for previously treated subaortic stenosis. Time to the second procedure was 2.8 to 7.4 years (mean 4.9 years). Follow-up is 0.4 to 14.0 years (median 5.6 years). Six-year actuarial freedom from reoperation is 66% ±15%. The angle between the plane of the outlet septum and the plane of the septal crest was measured in 10 normal hearts (86.4 ±13.7) and 10 hearts with atrioventricular septal defects (22.2 ±26.0; p <0.01). The outflow tract can be effectively shortened, widened, and the angle increased toward normal by augmenting the left side of the superior bridging leaflet and performing a fibromyectomy. Conclusion: Standard fibromyectomy for subaortic stenosis in children with atrioventricular septal defects leads to a high rate of reoperation. Leaflet augmentation and fibromyectomy may decrease the likelihood of reoperation. (J THORAC CARDIOVASC SURG 1995;110:1534-42

(Post-)queer citizenship in contemporary republican France

1996 saw the publication of Frédéric Martel’s Le Rose et le noir, a comprehensive study of three decades of gay life in metropolitan France. The predominantly anti-communitarian stance adopted by Martel in the epilogue to the first edition of his work had evolved, by the time of the book’s publication en poche in 2000, into a more nuanced view of the interactions and intersections between queer and republican identities in contemporary France. This development was influenced, in large part, by concrete changes which took place over the second half of the 1990s, centring around the introduction of the PACS in 1999, and leading to an ever-broadening debate. This paper will begin by setting forth the ways in which Martel’s position changed and analysing the attitudinal, social, and legislative backdrop which paved the way for such a change to occur. It will then bring Martel’s work into a dialogue with the writings of Eric Fassin and Maxime Foerster, both of whom have, like Martel, offered crucial analyses of the place of queer citizens within the contemporary French republic. Particular attention will first be paid to the ways in which Fassin, in his writings, has underlined the salience of the ‘droit du sol/droit du sang’ debate, traditionally associated with questions of ethnic belonging, in light of public and political discussions revolving around questions of queer kinship raised by the introduction of the PACS. This will lead into an examination of Foerster’s assertion that gay citizens of the Republic, in the era of the PACS, find themselves in a role previously held by women, in other words, as elements that require integration within a republican model. Foerster argues that this requirement to integrate is indicative of the fact that the traditional republican claim that the citizen is a blank canvas is at best misguided, and, at worst, has been deliberately subverted. This paper will examine the manner in which Martel and Fassin’s observations can be used to further strengthen the points raised by Foerster, concluding with the latter that a true engagement with the issues raised by debates around queer citizenship over the past decade can, in fact, allow the contemporary republican citizen to ‘devenir ceux [qu’il] est’. In other words, the article will conclude that the potential impact of the PACS legislation and the broader discussions it has provoked could be a renegotiation of the relationship between queer citizens and the republic

The Coq Proof Assistant Reference Manual : Version 6.1

Projet COQCoq is a proof assistant based on a higher-order logic allowing powerful definitions of functions. Coq V6.1 is available by anonymous ftp at ftp.inria.fr:/INRIA/Projects/coq/V6.1 and ftp.ens-lyon.fr:/pub/LIP/COQ/V6.

Intestinal Microbiota Composition of Interleukin-10 Deficient C57BL/6J Mice and Susceptibility to Helicobacter hepaticus-Induced Colitis

The mouse pathobiont Helicobacter hepaticus can induce typhlocolitis in interleukin-10-deficient mice, and H. hepaticus infection of immunodeficient mice is widely used as a model to study the role of pathogens and commensal bacteria in the pathogenesis of inflammatory bowel disease. C57BL/6J Il10[superscript −/−] mice kept under specific pathogen-free conditions in two different facilities (MHH and MIT), displayed strong differences with respect to their susceptibilities to H. hepaticus-induced intestinal pathology. Mice at MIT developed robust typhlocolitis after infection with H. hepaticus, while mice at MHH developed no significant pathology after infection with the same H. hepaticus strain. We hypothesized that the intestinal microbiota might be responsible for these differences and therefore performed high resolution analysis of the intestinal microbiota composition in uninfected mice from the two facilities by deep sequencing of partial 16S rRNA amplicons. The microbiota composition differed markedly between mice from both facilities. Significant differences were also detected between two groups of MHH mice born in different years. Of the 119 operational taxonomic units (OTUs) that occurred in at least half the cecum or colon samples of at least one mouse group, 24 were only found in MIT mice, and another 13 OTUs could only be found in MHH samples. While most of the MHH-specific OTUs could only be identified to class or family level, the MIT-specific set contained OTUs identified to genus or species level, including the opportunistic pathogen, Bilophila wadsworthia. The susceptibility to H. hepaticus-induced colitis differed considerably between Il10[superscript −/−] mice originating from the two institutions. This was associated with significant differences in microbiota composition, highlighting the importance of characterizing the intestinal microbiome when studying murine models of IBD.National Institutes of Health (U.S.) (Grant NIH P01-CA26731)National Institutes of Health (U.S.) (Grant NIH P30ES0026731)National Institutes of Health (U.S.) (Grant NIH R01-OD011141

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570