Robot-Assisted Resection of Left Ventricular Papillary Fibroelastoma Arising From the Mitral Chordal Apparatus

The application of robot-assisted thoracoscopy to cardiac surgery affords an opportunity to leverage the exceptional intraoperative exposure, visualization, and dexterity of the robotic platform. Here, we report the case of a 72-year-old woman who presented to our institution for evaluation of a left ventricular mass that was identified following workup for an embolic event. We present an intraoperative video that provides technical details of the robot-assisted resection of the lesion, which was found to be a left ventricular papillary fibroelastoma arising from the mitral chordal apparatus. This case highlights the advantages provided by the robotic platform, which permitted complete, minimally invasive surgical excision of the lesion while minimizing the burden of surgical trauma

Aortic Arch Reconstruction Using Nonvalved Femoral Vein Homograft in High-Risk Neonates

Aortic arch obstruction is often present with complex concomitant congenital heart defects (CHDs). The use of nonvalved femoral vein homograft (FVH) to reconstruct the aortic arch has distinct surgical advantages, including simplified reconstruction. We present an intraoperative video of a Yasui procedure utilizing FVH for aortic reconstruction in a 12-day-old (2.2 kg) neonate with right ventricular outflow tract obstruction, malalignment ventricular septal defect, aortic valve atresia, aortic arch hypoplasia, atrial septal defect, and ductal dependent systemic circulation. Further, we report outcomes for a series of three additional neonatal patients with complex CHD and aortic arch obstruction who underwent FVH arch reconstruction

Feeding behavior of \u3ci\u3eAphis glycines\u3c/i\u3e (Hemiptera: Aphididae) on soybeans exhibiting antibiosis, antixenosis, and tolerance resistance

Aphis glycines Matsumura (Hemiptera: Aphididae) is a serious pest of soybean in North America. Plant resistance is a valuable tool for the management of this pest, and a better understanding of the interactions between aphid and soybeans expressing varying levels and different categories of resistance can assist in the development of aphid resistant or tolerant genotypes. The electrical penetration graph (EPG) technique was used to evaluate the feeding behavior of A. glycines (biotype 1) on 4 soybean genotypes: (1) ‘Dowling’ (contains Rag1 gene and exhibits antibiosis); (2) PI 200538 (contains Rag2 gene and exhibits antixenosis); (3) KS4202 (exhibits tolerance); and (4) ‘SD76RR’ (susceptible to aphid). Aphids spent shorter periods in the sieve element phase on ‘Dowling’ and exhibited a greater number of pathway phases, non-probing events, and a longer time in nonprobing events in PI 200538 and ‘Dowling.’ For ‘SD76RR’ and KS4202, aphids demonstrated more sustained phloem ingestion, spent shorter time in non-probing events, and exhibited fewer pathway phases and potential drops. These results indicate that resistance factors are present in the phloem of ‘Dowling.’ For PI 200538, it is suggested that antixenotic factors are involved in resistance to A. glycines. Because KS4202 is tolerant to biotype 1 of A. glycines, the suitability of this genotype was expected already. This study provides important data that contribute to the understanding of how soybean aphids (biotype 1) feed on soybean genotypes with various aphid resistant genes and categories. In addition to assisting in the distinction between resistance categories, these results are useful in soybean breeding programs focusing on developing genotypes with greater resistance to insects. Aphis glycines Matsumura (Hemiptera: Aphididae) é uma das principais pragas da cultura da soja na América do Norte. Dentre as técnicas de manejo da praga, a resistência de plantas a insetos se destaca como uma ferramenta valiosa. Assim, uma melhor compreensão sobre as interações entre o afídeo e plantas de soja que expressam variáveis níveis e diferentes categorias de resistência, pode auxiliar no desenvolvimento de genótipos resistentes ao inseto. A técnica de EPG foi utilizada para avaliar o comportamento alimentar de A. glycines (biótipo 1) em 4 genótipos de soja: (1) ‘Dowling’ (contém gene Rag1 e expressa antibiose); (2) PI 200538 (contém gene Rag2 e expressa antixenose); (3) KS4202 (expressa tolerância); e (4) ‘SD76RR’ (suscetível ao afídeo). Os afídeos demonstraram curtos períodos de alimentação na fase de seiva em ‘Dowling’ e exibiram uma grande quantidade de fases de caminhamento estiletar, número de períodos de não-prova e longos período de não-prova em PI 200538 e ‘Dowling.’ Para ‘SD76RR’ e KS4202, os afídeos mostraram um maior período de alimentação em vasos do floema, apresentaram curtos períodos de não-prova e exibiram poucas fases de caminhamento estiletar, além de menor número de quedas de potencial. Os resultados indicam que fatores de resistência estão presentes nos vasos floemáticos de ‘Dowling.’ Para PI200538, sugere-se que fatores antixenóticos estão envolvidos na resistência a A. glycines. Uma vez que KS4202 expressa tolerância ao biótipo 1 de A. glycines, a adequabilidade deste genótipo como fonte de alimento para o inseto já era esperada. Este estudo fornece importantes dados que contribuem para um melhor entendimento de como o pulgão-da-soja (biótipo 1) se alimentam de plantas de soja portadoras de diferentes genes e categorias de resistência. Além de auxiliar na distinção entre as categorias de resistência, esses resultados podem ser úteis em programas de melhoramento de soja, com intuito de selecionar genótipos mais resistentes a insetos

Feeding behavior of \u3ci\u3eAphis glycines\u3c/i\u3e (Hemiptera: Aphididae) on soybeans exhibiting antibiosis, antixenosis, and tolerance resistance

Aphis glycines Matsumura (Hemiptera: Aphididae) is a serious pest of soybean in North America. Plant resistance is a valuable tool for the management of this pest, and a better understanding of the interactions between aphid and soybeans expressing varying levels and different categories of resistance can assist in the development of aphid resistant or tolerant genotypes. The electrical penetration graph (EPG) technique was used to evaluate the feeding behavior of A. glycines (biotype 1) on 4 soybean genotypes: (1) ‘Dowling’ (contains Rag1 gene and exhibits antibiosis); (2) PI 200538 (contains Rag2 gene and exhibits antixenosis); (3) KS4202 (exhibits tolerance); and (4) ‘SD76RR’ (susceptible to aphid). Aphids spent shorter periods in the sieve element phase on ‘Dowling’ and exhibited a greater number of pathway phases, non-probing events, and a longer time in nonprobing events in PI 200538 and ‘Dowling.’ For ‘SD76RR’ and KS4202, aphids demonstrated more sustained phloem ingestion, spent shorter time in non-probing events, and exhibited fewer pathway phases and potential drops. These results indicate that resistance factors are present in the phloem of ‘Dowling.’ For PI 200538, it is suggested that antixenotic factors are involved in resistance to A. glycines. Because KS4202 is tolerant to biotype 1 of A. glycines, the suitability of this genotype was expected already. This study provides important data that contribute to the understanding of how soybean aphids (biotype 1) feed on soybean genotypes with various aphid resistant genes and categories. In addition to assisting in the distinction between resistance categories, these results are useful in soybean breeding programs focusing on developing genotypes with greater resistance to insects. Aphis glycines Matsumura (Hemiptera: Aphididae) é uma das principais pragas da cultura da soja na América do Norte. Dentre as técnicas de manejo da praga, a resistência de plantas a insetos se destaca como uma ferramenta valiosa. Assim, uma melhor compreensão sobre as interações entre o afídeo e plantas de soja que expressam variáveis níveis e diferentes categorias de resistência, pode auxiliar no desenvolvimento de genótipos resistentes ao inseto. A técnica de EPG foi utilizada para avaliar o comportamento alimentar de A. glycines (biótipo 1) em 4 genótipos de soja: (1) ‘Dowling’ (contém gene Rag1 e expressa antibiose); (2) PI 200538 (contém gene Rag2 e expressa antixenose); (3) KS4202 (expressa tolerância); e (4) ‘SD76RR’ (suscetível ao afídeo). Os afídeos demonstraram curtos períodos de alimentação na fase de seiva em ‘Dowling’ e exibiram uma grande quantidade de fases de caminhamento estiletar, número de períodos de não-prova e longos período de não-prova em PI 200538 e ‘Dowling.’ Para ‘SD76RR’ e KS4202, os afídeos mostraram um maior período de alimentação em vasos do floema, apresentaram curtos períodos de não-prova e exibiram poucas fases de caminhamento estiletar, além de menor número de quedas de potencial. Os resultados indicam que fatores de resistência estão presentes nos vasos floemáticos de ‘Dowling.’ Para PI200538, sugere-se que fatores antixenóticos estão envolvidos na resistência a A. glycines. Uma vez que KS4202 expressa tolerância ao biótipo 1 de A. glycines, a adequabilidade deste genótipo como fonte de alimento para o inseto já era esperada. Este estudo fornece importantes dados que contribuem para um melhor entendimento de como o pulgão-da-soja (biótipo 1) se alimentam de plantas de soja portadoras de diferentes genes e categorias de resistência. Além de auxiliar na distinção entre as categorias de resistência, esses resultados podem ser úteis em programas de melhoramento de soja, com intuito de selecionar genótipos mais resistentes a insetos

The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

OBJECTIVES: Men who pay for sex (MPS) are considered a bridging population for sexually transmitted infections (STI). However, the extent, characteristics and role of MPS in transmission is poorly understood. We investigate these questions using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). METHODS: We performed complex survey analyses of data from 6293 men aged 16-74 years resident in Britain who completed Natsal-3, a probability sample survey undertaken during 2010-2012, using computer-assisted personal interviewing and computer-assisted self-interview. RESULTS: 11.0% (95% CI10.1% to 11.9%) of all men reported ever paying for sex. Among MPS, 18.4% (95% CI 18.2% to 18.7%) of their lifetime sexual partners were paid. 3.6% (95% CI 3.1% to 4.2%) of men had paid for sex in the past 5 years. Partners of MPS constitute 14.7% of all reported partners and MPS report 15.6% of all reported STI diagnoses in the past 5 years. Paying for sex in the past 5 years was strongly associated with reporting larger numbers of sexual partners (adjusted OR, AOR for 5+ partners, past 5 years, 31.50, 95% CI 18.69 to 53.09). After adjusting for partner numbers, paying for sex remained strongly associated with reporting new foreign partners outside the UK (AOR 7.96; 95% CI 4.97 to 12.73) and STI diagnosis/es (AOR 2.34; 95% CI 1.44 to 3.81), all in the past 5 years. Among men ever paying for sex, 62.6% (95% CI 58.3% to 66.8%) reported paying for sex outside the UK, most often in Europe and Asia. CONCLUSIONS: MPS in Britain remain at greater risk of STI acquisition and onward transmission than men who do not. They report high numbers of partners, but the minority are paid partners. They are an important core group in STI transmission

Navigating new sexual partnerships in midlife: a socioecological perspective on factors shaping STI risk perceptions and practices.

OBJECTIVE: Despite increases in STIs among those over 40, little is known about the social context of STI transmission among people experiencing relationship transition in midlife, and few sexual health promotion initiatives are targeted at this group. This study sought to identify factors shaping STI risk perceptions and practices among midlife individuals either contemplating or having sex with new partners following the end of a long-term relationship. METHODS: Participants were purposively selected from respondents to Britain's third National Survey of Sexual Attitudes and Lifestyles, using three eligibility criteria: aged 40-59, reported experience of the end of a marital or cohabiting relationship with an opposite-sex partner in the past 5 years, and willingness to participate in a qualitative interview. Qualitative data were generated via face-to-face interviews with 10 women and 9 men and analysed inductively using thematic analysis, with themes then organised using a socioecological framework. RESULTS: Participants' accounts of new sexual partnerships in midlife indicate that STI risk perceptions and practices are shaped by factors operating at multiple levels across the socioecological arena (individual, partnership, peers and communities, societal). Constraints on, and resources for, the navigation of sexual safety include self-perceived STI risk rooted in past rather than present circumstances; legacies of mistrust within former relationships; intersecting gender-age dynamics in negotiation of risk prevention strategies with new partners; peers and younger relatives' influences on understandings of sexual risk and safety; postrelationship change in social networks that increase or mitigate vulnerability to sexual risk; age-related barriers to accessing condoms; and disconnection from safer sex messaging and services culturally coded as for the young. CONCLUSIONS: Improving sexual health among midlife adults requires age-sensitive interventions designed to address multilevel constraints, and harness positive influences, on the navigation of sexual safety at this stage of life

Estimating the prevalence of sexual function problems: the impact of morbidity criteria

Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of these three criteria on the population prevalence of sexual function problems. The data come from a national probability survey (Natsal-3) and are based on 11,509 male and female participants aged 16–74, reporting at least one sexual partner in the past year. The key outcomes were: proportion of individuals reporting proxy measures of DSM-5 problems, and the proportion of those meeting morbidity criteria. We found that among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but 4.2% after applying the three morbidity criteria; corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. Just over a third of men and women reporting a problem meeting all three morbidity criteria had sought help in the last year. We conclude that the DSM-5 morbidity criteria impose a focus on clinically significant symptom

Authors’ reply re: painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey

No abstract available