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Research to reduce maternal morbidity due to cardiovascular disease is vitally important in the United States, especially for the growing number of individuals with congenital heart disease (CHD) reaching childbearing age. Understanding patient experiences through patient engagement is critical to designing research that is aligned with the needs of adults with CHD undergoing pregnancy. This patient engagement project, grounded in human centered design, focuses on the discovering patient and healthcare provider priorities for reducing maternal morbidity in CHD through patient centered outcomes research (PCOR). In this first stage, a capacity building consortium of over 90 key partners, including patients, advocates, healthcare providers, and researchers, was assembled. Baseline education on patient engagement, PCOR, and survey instrument design was delivered virtually. Two questionnaires were designed to elicit tacit knowledge – 1 for patients and 1 for providers – regarding gaps and needs across 4 key pillars: access to clinical care, patient and provider education, mental health, and research opportunities. The pillars were determined through thematic summaries from consortium discussions. The patient questionnaire received 828 responses (age range: 18-60 years) from 48 U.S. states. The provider questionnaire garnered 218 responses from professionals. Several common themes for areas of research were observed across all pillars including improved access to specialized cardio-obstetric care and improved education about the need for specialized care. Healthcare providers cited insufficient care coordination models and resources as a major barrier to providing effective clinical care. Both patients and providers expressed a need for improved access to mental health care. While only 28% of patient respondents who underwent a pregnancy reported a pre-existing mental health diagnosis, nearly 2/3 reported having significant anxiety symptoms related to their pregnancy. Of those with significant symptoms, 44% were unable to access mental health services. Additionally, only 55% of healthcare providers reported referral for assessment and treatment if mental health concerns arose during or after pregnancy. The results provide valuable insights into the unique challenges faced by patients with CHD and their providers during pregnancy. By addressing the identified gaps through PCOR, we can work towards a goal to improve maternal care for women with CHD. [ABSTRACT FROM AUTHOR]

A leading cause of anatomic total shoulder arthroplasty failure continues to be glenoid component loosening. Historically, metal-backed glenoids (MBGs) have shown decreased performance compared with polyethylene-backed glenoid (PEG) components. Previous studies have shown that MBG components have higher revision rates and shorter time to prosthetic failure compared with PEG components. However, the negative outcomes of many of these studies may have been linked to an examination of older generations of MBG implants, and do not account for newer technology. Thus, our study aims to assess the short-term radiographic and clinical outcomes of patients treated with anatomic total shoulder arthroplasty using the current and more modern generation of implants with a universal metal-backed glenoid component. We conducted a retrospective chart review of patients who had their primary anatomic shoulder replacement performed from 2017 to 2022 by a single surgeon, and used one of 2 currently available implants that incorporated a metal-backed glenoid component with a convertible baseplate. After the exclusion of those lost to follow-up, we included 26 patients in this study, 3 of whom underwent bilateral shoulder replacement surgery at staggered time intervals. The primary outcome measure was evidence of radiographic change via in-office X-ray reports. Analysis of radiographic changes was conducted for each postoperative visit, which was aimed for 2 weeks, 6 weeks, 12 weeks, 1 year, and annually thereafter. Secondary analysis tracked clinical progression and used Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) scores, range of motion evaluation, strength testing, and instability examination using evidence of apprehension and sulcus signs at each time interval. In our study, radiographic changes at each time interval and the longest follow-up appointment demonstrated no evidence of hardware loosening of either the glenoid or the humeral component and no evidence of periprosthetic fracture or hardware failure of any kind for MBG implants. There were no revisions performed because of polyethylene wear. The overall average range of motion, strength, and DASH scores were improved at each postoperative visit. Previous studies have suggested that TSA implants with MBG components may be inferior to PEG implants. However, the results of many of these studies may not be as representative of the current implant designs available today. Although additional studies are necessary to assess the long-term survivability of the implant and its effects on glenoid bone stock, our findings suggest that university MBG components have minimal complications, do not demonstrate loosening, and have acceptable outcomes in short-term follow-up. [ABSTRACT FROM AUTHOR]

Data processed in context is more meaningful, easier to understand and has higher information content, hence it derives its semantic meaning from the surrounding context. Even in the field of acoustic signal processing. In this work, a Deep Learning based approach using Ensemble Neural Networks to integrate context into a learning system is presented. For this purpose, different use cases are considered and the method is demonstrated using acoustic signal processing of machine sound data for valves, pumps and slide rails. Mel-spectrograms are used to train convolutional neural networks in order to analyse acoustic data using image processing techniques. [ABSTRACT FROM AUTHOR]

Osteocytes act as bone mechanosensors, regulators of osteoblast/osteoclast activity and mineral homeostasis, however, knowledge about their functional/morphological changes throughout life is limited. We used quantitative backscattered electron imaging (qBEI) to investigate osteocyte lacunae sections (OLS) as a 2D-surrogate characterizing the osteocytes. OLS characteristics, the density of mineralized osteocyte lacunae (i.e., micropetrotic osteocytes, md.OLS-Density in nb/mm2) and the average degree of mineralization (Ca Mean in weight% calcium) of cortex and spongiosa were analyzed in transiliac biopsy samples from healthy individuals under 30 (n=59) and over 30 years (n=50) (i.e., before and after the age of peak bone mass, respectively). We found several differences in OLS-characteristics: 1). Inter-individually between the age groups: OLS-Density and OLS-Porosity were reduced by about 20% in older individuals in spongiosa and in cortex versus younger probands (both, p < 0.001). 2). Intra-individually between bone compartments: OLS-Density was higher in the cortex, +18.4%, p < 0.001 for younger and +7.6%, p < 0.05 for older individuals. Strikingly, the most frequent OLS nearest-neighbor distance was about 30 µm in both age groups and at both bone sites revealing a preferential organization of osteocytes in clusters. OLS-Density was negatively correlated with Ca Mean in both spongiosa and cortex (both, p < 0.001). Few mineralized OLS were found in young individuals along with an increase of md.OLS-Density with age. In summary, this transiliac bone sample analysis of 200000 OLS from 109 healthy individuals throughout lifespan reveals several age-related differences in OLS characteristics. Moreover, our study provides reference data from healthy individuals for different ages to be used for diagnosis of bone abnormalities in diseases. Osteocytes are bone cells embedded in lacunae within the mineralized bone matrix and have a key role in the bone metabolism and the mineral homeostasis. Not easily accessible, we used quantitative backscattered electron imaging to determine precisely number and shape descriptors of the osteocyte lacunae in 2D. We analyzed transiliac biopsy samples from 109 individuals with age distributed from 2 to 95 years. Compact cortical bone showed constantly higher lacunar density than cancellous bone but the lacunar density in both bone tissue decreased with age before the peak bone mass age at 30 years and stabilized or even increased after this age. This extensive study provides osteocyte lacunae reference data from healthy individuals usable for bone pathology diagnosis. [Display omitted] [ABSTRACT FROM AUTHOR]

OBJECTIVES: TO assess the association between racial dis-crimination, race and ethnicity, and social class with child health and unmet health care needs among children in the United States (US). METHODS: We used a nationally representative sample of children aged 0 to 17 from the 2018-2019 National Survey of Children's Health. Bivariate and multivariable logistic regression were used to test associations between measures of discrimination, social class (income, employment, and education), and race and ethnicity with overall child health and unmet health care needs controlling for covariates identified a priori. RESULTS: Overall, 90.3% of children (n = 59,964) had excel-lent/very good overall health; 3.1% had unmet health care needs. Black, non-Hispanic children held 8.9 times the odds of having experienced racial discrimination compared to White, non-Hispanic children (95% confidence interval [CI], 7.0 - 11.4). Having special health care needs was significantly associated with greater odds of racial discrimination (OR 2.3; 95% CI, 1.9-2.8). In multivariable models, underrepresented race and ethnicity groups, lower household income level, and lower caregiver education were significantly associated with poorer overall child health. Conversely, experiencing discrimi-nation was not significantly associated with excellent/good overall child health (adjusted odds ratios [aORs], 0.8; 95% CI, 0.6-1.1) Racial discrimination (aOR 2.7; 95% CI, 1.9-4.0) and lower household income (aOR 2.6; 95% CI, 1.8-3.5) were associated with significantly greater odds of unmet health care needs. CONCLUSION: Race and ethnicity and low social class were significantly associated with worse overall health while racial discrimination and low-income were associated with more unmet health care needs. These findings underscore the importance of policy and health care system innovations that address the effects of racism and poverty on child health. [ABSTRACT FROM AUTHOR]

The field of pediatrics has pioneered approaches to mitigating poverty's harmful effects on children's health and development. Clinical interventions for systematically addressing material hardships due to poverty within the context of pediatric care delivery, however, are still in their infancy. Since the American Academy of Pediatrics published its policy statement on Child Health and Poverty in the United States in 2016, interest has surged in the development and implementation of care models that systematically identify and address social risks and/or social needs. This article explores this major shift in interest, research, and investment in such interventions within pediatric care. We provide an overview of current screening and referral models for addressing poverty-related social factors and explore the strengths and weaknesses of these varied approaches. We summarize the current evidence supporting such clinical approaches, and comment on the importance of multi-sectoral partnerships in addressing families' and communities' needs. Lastly, we propose future directions for research and pediatric practice that may enhance the uptake of social risks/needs interventions and bolster the evidence of their effectiveness. Though clinical approaches for addressing material hardship may be limited by an insufficient social safety net and other barriers, interventions to identify and address families' social risks and social needs have the potential to combat poverty's impact on children and advance health equity. [ABSTRACT FROM AUTHOR]

• Novel mimotope-based ELISA exclusively measures intact natalizumab. • Pharmacokinetics and endogenous IgG4 levels influence levels of intact natalizumab. • High levels of intact natalizumab may increase the risk of adverse events. • Monitoring intact natalizumab identifies the need for adjustment of dosing regimen. • Natalizumab levels in non-invasive saliva samples show good correlation with serum. Natalizumab (NAT) pharmacokinetics and pharmacodynamics are complicated by arm exchange with endogenous IgG4, resulting in a mixture of a more potent intact, bivalent form and a less potent, functionally monovalent form. Total NAT and endogenous IgG4 concentrations vary considerably across patients. This study assessed the concentration of intact NAT, and how it relates to total NAT and endogenous IgG4 levels in blood and saliva. Paired serum and saliva samples from a small cohort of relapsing-remitting multiple sclerosis patients were measured for levels of intact NAT, total NAT, IgG and IgG4. Intact NAT concentration was dependent on both total NAT and endogenous IgG4 levels. Low endogenous IgG4 led to a higher ratio of intact NAT to total NAT, while the opposite was observed in subjects with high endogenous IgG4. Serum and saliva measurements show good concordance. Intact NAT concentration is influenced by both NAT pharmacokinetics and endogenous IgG4 levels. Patients with low IgG4 levels can have high concentrations of intact NAT even with lower levels of total NAT, which may explain cases of NAT-associated progressive multifocal leukoencephalopathy (PML) in such patients. Monitoring both forms of NAT could better guide dosing, maximizing drug efficacy and safety. [ABSTRACT FROM AUTHOR]

Post-operative acute kidney injury (AKI) is a frequent peri-operative complication that negatively affects morbidity and mortality. Mannitol is frequently used peri-operatively for renal protection, although evidence for its use is ambiguous. A systematic review was conducted to clarify whether there is evidence supporting peri-operative mannitol administration for the prevention of post-operative AKI. A systematic literature search was performed in MEDLINE/Pubmed, Embase, the Cochrane Library, Clinical Trials registry, and the Cochrane Central Register of Controlled Trials (CENTRAL). Eligibility criteria were (i) population (studies involving adult patients undergoing surgery or a related intervention); (ii) intervention (intravenous mannitol administered in either the pre- or intra-operative period with comparison to controls); and (iii) predefined outcomes (post-operative AKI or respective renal end points/surrogates). In total, 1,538 articles published between January 1990 and October 2018 were identified. After checking for eligibility, 22 studies, including 17 prospective and/or randomised controlled trials and five retrospective studies, were included. The investigations involved various fields of surgery, such as aortic surgery, cardiac surgery with cardiopulmonary bypass, and urological procedures, including partial nephrectomy. Significant heterogeneity, limited sample size, and mostly short follow up periods were noted. Given the available evidence, the peri-operative use of mannitol to prevent AKI cannot be considered an evidence based intervention in cardiac surgery, partial nephrectomy, and/or other major surgery. Further research is required with a focus on patients at high risk of post-operative AKI. [ABSTRACT FROM AUTHOR]

Abstract Numerous hypotheses have been put forward to account for population outbreaks of crown-of-thorns starfishes (CoTS, Acanthaster spp.), which place specific importance on either pre- or post-settlement mechanisms. The purpose of this review is to specifically assess the contributions of pre- versus post-settlement processes in the population dynamics of CoTS. Given the immense reproductive potential of CoTS (>100 million eggs per female), persistent high densities would appear inevitable unless there were significant constraints on larval development, settlement success, and/or early post-settlement growth and survival. In terms of population constraints, pre- and post-settlement processes are both important and have additive effects to suppress densities of juvenile and adult CoTS within reef ecosystems. It is difficult, however, to assess the relative contributions of pre- versus post-settlement processes to population outbreaks, especially given limited data on settlement rates, as well as early post-settlement growth and mortality. Prioritising this research is important to resolve potential effects of anthropogenic activities (e.g., fishing) and habitat degradation on changing population dynamics of CoTS, and will also improve management effectiveness. [ABSTRACT FROM AUTHOR]

Highlights • Patient Information Sheet (PIS) used in MS clinical trials may not be understandable. • User testing (UT) highlighted critical issues in two PIS from clinical trials in MS. • UT is a useful tool for verifying the comprehensibility of PIS. • Developing PIS should involve different stakeholders with specific experience. Abstract The Patient Information Sheet (PIS) is an important aspect of the consent process in a clinical trial that provides potential participants the necessary information for deciding whether to take part in a specific study and for understanding their rights pertaining to participation. User Testing was originally developed to assess how written information about medicinal products performs with its intended users. User testing has been proposed in a small number of clinical trials and has been able to identify subjects' ability or inability to find and understand important information related to providing a valid consent to participate. A 21-item ad hoc user testing questionnaire was applied to 2 PIS used in clinical trials in MS. Sixty subjects were allocated to a group testing an observational study PIS (O-PIS) or to a group testing an intervention study PIS (I-PIS). In the O-PIS group, 19.4% of subjects located all relevant information within the text (21/21) and 3.4% of subjects in the I-PIS group. Overall, 82.1% of subjects testing the O-PIS understood the text and 53.5% of subjects testing the I-PIS understood the text. In the category 'nature and purpose of the trial', one-third of subjects did not understand the text, including the aim of the study. User testing should be considered as a valid tool in evaluating the comprehensibility of PIS in the context of clinical trials MS to assure that subjects provide a valid consent to participate. [ABSTRACT FROM AUTHOR]

Drug resistance in the salmon louse Lepeophtheirus salmonis is a global issue for Atlantic salmon aquaculture. Multiple resistance has been described across most available compound classes with the exception of the benzoylureas. To target this gap in effective management of L. salmonis and other species of sea lice (e.g. Caligus spp.), Elanco Animal Health is developing an in-feed treatment containing lufenuron (a benzoylurea) to be administered prior to seawater transfer of salmon smolts and to provide long-term protection of salmon against sea lice infestations. Benzoylureas disrupt chitin synthesis, formation, and deposition during all moulting events. However, the mechanism(s) of action are not yet fully understood and most research completed to date has focused on insects. We exposed the first parasitic stage of L. salmonis to 700 ppb lufenuron for three hours and observed over 90% reduction in survival to the chalimus II life stage on the host, as compared to vehicle controls. This agrees with a follow up in vivo administration study on the host, which showed >95% reduction by the chalimus I stage. Transcriptomic responses of salmon lice exposed to lufenuron included genes related to moulting, epithelial differentiation, solute transport, and general developmental processes. Global metabolite profiles also suggest that membrane stability and fluidity is impacted in treated lice. These molecular signals are likely the underpinnings of an abnormal moulting process and cuticle formation observed ultrastructurally using transmission electron microscopy. Treated nauplii-staged lice exhibited multiple abnormalities in the integument, suggesting that the coordinated assembly of the epi- and procuticle is impaired. In all cases, treatment with lufenuron had rapid impacts on L. salmonis development. We describe multiple experiments to characterize the efficacy of lufenuron on eggs, larvae, and parasitic stages of L. salmonis , and provide the most comprehensive assessment of the physiological responses of a marine arthropod to a benzoylurea chemical. [ABSTRACT FROM AUTHOR]

Abstract Antiparasitic drugs such as emamectin benzoate (EMB) are relied upon to reduce the parasite load, particularly of the sea louse Lepeophtheirus salmonis, on farmed salmon. The decline in EMB treatment efficacy for this purpose is an important issue for salmon producers around the world, and particularly for those in the Atlantic Ocean where widespread EMB tolerance in sea lice is recognized as a significant problem. Salmon farms in the Northeast Pacific Ocean have not historically experienced the same issues with treatment efficacy, possibly due to the relatively large population of endemic salmonid hosts that serve to both redistribute surviving lice and dilute populations potentially under selection by introducing naïve lice to farms. Frequent migration of lice among farmed and wild hosts should limit the effect of farm-specific selection pressures on changes to the overall allele frequencies of sea lice in the Pacific Ocean. A previous study using microsatellites examined L. salmonis oncorhynchi from 10 Pacific locations from wild and farmed hosts and found no population structure. Recently however, a farm population of sea lice was detected where EMB bioassay exposure tolerance was abnormally elevated. In response, we have developed a Pacific louse draft genome that complements the previously-released Atlantic louse sequence. These genomes were combined with whole-genome re-sequencing data to design a highly sensitive 201,279 marker SNP array applicable for both subspecies (90,827 validated Pacific loci; 153,569 validated Atlantic loci). Notably, kmer spectrum analysis of the re-sequenced samples indicated that Pacific lice exhibit a large within-individual heterozygosity rate (average of 1 in every 72 bases) that is markedly higher than that of Atlantic individuals (1 in every 173 bases). The SNP chip was used to produce a high-density map for Atlantic sea louse linkage group 5 that was previously shown to be associated with EMB tolerance in Atlantic lice. Additionally, 478 Pacific louse samples from farmed and wild hosts obtained between 2005 and 2014 were also genotyped on the array. Clustering analysis allowed us to detect the apparent emergence of an otherwise rare genotype at a high frequency among the lice collected from two farms in 2013 that had reported elevated EMB tolerance. This genotype was not observed in louse samples collected from the same farm in 2010, nor in any lice sampled from other locations prior to 2013. However, this genotype was detected at low frequencies in louse samples from farms in two locations reporting elevated EMB tolerance in 2014. These results suggest that a rare genotype present in Pacific lice may be locally expanded in farms after EMB treatment. Supporting this hypothesis, 437 SNPs associated with this genotype were found to be in a region of linkage group 5 that overlaps the region associated with EMB resistance in Atlantic lice. Finally, five of the top diagnostic SNPs within this region were used to screen lice that had been subjected to an EMB survival assay, revealing a significant association between these SNPs and EMB treatment outcome. To our knowledge this work is the first report to identify a genetic link to altered EMB efficacy in L. salmonis in the Pacific Ocean. [ABSTRACT FROM AUTHOR]

Cypermethrin has been administered for decades to control salmon lice ( Lepeophtheirus salmonis ) infestations in Atlantic salmon farming regions globally. However, resistance to cypermethrin and other available therapeutants has threatened the sustainability of this growing industry. To better understand the effects of cypermethrin on L. salmonis , a 38 K oligonucleotide microarray and RT-qPCR analyses were applied to pools of copepodid larvae exposed to 1.0 ppb cypermethrin or seawater controls for 24 h. Phenotypic assessments and global gene expression profiles showed a significant disruption of homeostasis in copepodid L. salmonis exposed to cypermethrin. Multiple degradative enzymes were overexpressed in cypermethrin-treated lice including five trypsin-like serine proteases and three cytochrome p450s CYP3a24 ( p = 0.03, fold change (FC) = 3.8; GenBank accession no. JP326960.1 ), CYP6w1 ( p = 0.008, FC = 5.3; GenBank accession no. JP317875.1 ), and CYP6d4 ( p = 0.01; FC = 7.9; GenBank accession no. JP334550.1 ). These enzymes represent preliminary markers for understanding the physiological response of L. salmonis to cypermethrin exposure. A general stress response was also observed in cypermethrin-treated lice which included differential expression of cell signaling genes involved in the induction of cell growth, solute transport, and metabolism. Lastly, a consensus-based analysis was completed with two previously published L. salmonis transcriptome studies revealing genes that respond to cypermethrin, emamectin benzoate (another delousing agent) and hyposalinity. This included concordant differential expression of heat shock beta-1 , ammonium transporter Rh types B , and 72 kDa type IV collagenase across different L. salmonis studies. This is currently the most comprehensive transcriptome assessment of chemical exposure on the first infectious stage of L. salmonis , providing novel markers for studying drug resistance and general stress in this important parasite. [ABSTRACT FROM AUTHOR]

We present our low cost assembly unit to manufacture back contact solar modules based on the conductive backsheet (CBS) approach. This in house developed apparatus was built to assemble test modules containing one up to four 6 inch back contact solar cells. The system is a retrofit of a commercially available CNC system which is equipped with a cell grabber and a manual dispensing system (by Nordson). The total cost of the setup was roughly 4000 € excluding the dispenser unit. Using this equipment we assembled several small size modules containing one and four Zebra cells, which are low cost 6 inch IBC solar cells developed at ISC Konstanz [1,2] . The contact between copper backsheet and back contact cell of the one cell modules we present here is formed by low temperature solder paste (LTSP). First cell to module (CTM) loss evaluations and reliability results suggest that this material could be a viable alternative to electrically conductive adhesive (ECA) which is currently the most commonly used material for this purpose. [ABSTRACT FROM AUTHOR]

The combination of "hard", structurally well-defined particles with "soft", functional compartments bears great potential to produce structurally intricate hybrid nanomaterials that promote a multitude of applications that require multimodal agents and that permit the production of molecular factories. However, the co-assembly of "hard" and "soft" components in a programmable and directional manner is challenging due to the strongly differing mechanical properties of such disparate entities. Here, a versatile strategy to generate clusters by the directional and controlled self-organization of "hard" Janus nanoparticles (JNPs) with "soft" polymersomes is described. The hybridization of complementary ssDNA strands bound to the components drives cluster formation, while the asymmetry of the JNPs governs the directionality of the self-organization. Various factors have been explored to simultaneously preserve the integrity of the polymersomes and program the cluster formation. Differently loaded polymersomes on each lobe of the JNPs preserved their architecture in the clusters which, were shown to be non-toxic when interacting with cell lines. The architecture of the clusters, as a molecular factory where each component can be separately controlled bears great promise for use in advanced medical applications, including theranostics and correlative imaging. [Display omitted] • Polymersomes and heterofunctional Janus nanoparticles are assembled into well-defined hybrid clusters. • Directional self-organization mediated by ssDNA overcomes challenges in co-assembling hard and soft components. • Directionality of self-organization render the cluster preparation programmable and modular in composition and function. • The hybrid clusters are shown to be biocompatible, interacting strongly with cell surfaces. • Prospective applications include correlative imaging, reaction cascades, and nanotheranostics. [ABSTRACT FROM AUTHOR]

Objective We studied brain structure abnormalities in adolescents and young adults who had undergone the neonatal arterial switch operation for transposition of the great arteries and related them to the neurologic and psycho-intellectual outcomes. Methods In a prospective longitudinal study, 60 unselected adolescents and young adults who had undergone surgery with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were re-evaluated at a mean age of 16.9 ± 1.7 years to determine their clinical neurologic status, intellectual development, and psychological condition. The results were related to population norms and anatomic structural abnormalities assessed by brain magnetic resonance imaging, with consideration of the risk factors in the preoperative and perioperative periods. Results Neurologic impairment was more frequent (10%) than in the normal population. Although the average full-scale, verbal, and performance intelligence quotients were not reduced, scores >2 standard deviations less than the expected mean were increased. Above average scores were found for analytical thinking, but the orthography testing results were reduced. The self-rated psychological condition was better than expected. Magnetic resonance imaging demonstrated moderate or severe structural brain abnormalities in 32% of the patients. Periventricular leukomalacia was detected in >50%; its severity correlated with the grade of neurologic impairment, which correlated significantly with reduced intelligence, analytical thinking, and orthography. Preoperative acidosis and hypoxia were the only independent patient-related risk factors for neurologic dysfunction, reduced intelligence, periventricular leukomalacia, and reduced brain volume. Conclusions Despite encouraging overall neurodevelopmental outcomes, a significant minority had performances below the expected level, emphasizing the need for ongoing surveillance. Considering the high frequency of structural brain abnormalities, prospective long-term studies are needed to define their prognostic value with respect to the neuropsychological outcomes in childhood and adolescence. [ABSTRACT FROM AUTHOR]

White lupin (Lupinus albus L.) is a promising crop to meet the rising global demand for plant-based protein. The seed-borne pathogen Colletotrichum lupini , however, threatens lupin cultivation worldwide. Seed dressings using synthetic fungicides were shown effective to reduce infection levels, but their negative environmental impact and exclusion from organic production calls for more sustainable solutions. In this study, a total of eleven different alternative seed treatments were tested in field trials in Switzerland between 2018 and 2021. Treatment types consisted of: hot water, steam, electron, long-term storage, elevated partial pressure of oxygen (EPPO), vinegar, plant extracts and biological control agents (BCAs). The BCAs were tested for potential antagonistic activity against C. lupini during white lupin infection under controlled conditions prior to field trials. Long-term storage and vinegar treatments successfully reduced disease incidence and increased yield to levels similar to those observed for certified seeds, without significantly affecting germination rate. Although promising, effectiveness of these treatments needs further validation. Four BCAs showed significant disease reductions under controlled conditions. Besides lowering disease severity, two BCAs also reduced C. lupini DNA in stem tissue. These reductions, however, were not observed in the field, highlighting the importance of field validations. The treatments identified in this study provide a solid basis for the development of sustainable and effective seed protection strategies in white lupin to control C. lupini successfully. • Seed storage and vinegar reduce anthracnose incidence under on-farm field conditions. • Certified seed is essential to limit primary anthracnose infection. • High temperature seed treatments can severely affect germination rate. [ABSTRACT FROM AUTHOR]

The American Nurses Foundation (ANF) grant program has been successful in funding nurse researchers' initial research studies for nearly 60 years. (ANF, 2013). From 1955-2012, over 1,000 ANF scholars have been identified through this historical nursing research study. Over the years, obtaining an ANF grant has become increasingly competitive for scholars. The environment supportive of research is evident from the schools that are the top recipients of grants. The ANF has a proud legacy of scholars who have and continue to make contributions to the advancement of nursing science. The paths forged by the ANF scholars illustrate the significant role that small grant programs play in the evolvement of nursing research and the expansion of nursing science. [ABSTRACT FROM AUTHOR]

Human serum albumin (HSA) is used as a plasma expander; however, albumin is readily eliminated from the intravascular space. The objective of this study was to establish the effects of various-sized polymerized HSAs (PolyHSAs) during small-volume resuscitation from hemorrhagic shock on systemic parameters, microvascular hemodynamics, and functional capillary density in the hamster window chamber model. Polymerized HSA size was controlled by varying the cross-link density (ie, molar ratio of glutaraldehyde to HSA). Hemorrhage was induced by controlled arterial bleeding of 50% of the animal's blood volume (BV), and hypovolemic shock was maintained for 1 hour. Resuscitation was implemented in 2 phases, first, by infusion of 3.5% of the BV of hypertonic saline (7.5% NaCl) then followed by infusion of 10% of the BV of each PolyHSA. Resuscitation provided rapid recovery of blood pressure, blood gas parameters, and microvascular perfusion. Polymerized HSA at a glutaraldehyde-to-HSA molar ratio of 60:1 (PolyHSA60:1) provided superior recovery of blood pressure, microvascular blood flow, and functional capillary density, and acid-base balance, with sustained volume expansion in relation to the volume infused. The high molecular weight of PolyHSA60:1 increased the hydrodynamic radius and solution viscosity. Pharmacokinetic analysis of PolyHSA60:1 indicates reduced clearance and increased circulatory half-life compared with monomeric HSA and other PolyHSA formulations. In conclusion, HSA molecular size and solution viscosity affect central hemodynamics, microvascular blood flow, volume expansion, and circulation persistence during small-volume resuscitation from hemorrhagic shock. In addition, PolyHSA can be an alternative to HSA in pathophysiological situations with compromised vascular permeability. [Copyright &y& Elsevier]

Abstract: Nanoparticles (NPs) are attractive carriers for vaccines. We have previously shown that a short peptide (Hp91) activates dendritic cells (DCs), which are critical for initiation of immune responses. In an effort to develop Hp91 as a vaccine adjuvant with NP carriers, we evaluated its activity when encapsulated in or conjugated to the surface of poly(d,l-lactic-co-glycolic) acid (PLGA) NPs. We found that Hp91, when encapsulated in or conjugated to the surface of PLGA-NPs, not only activates both human and mouse DCs, but is in fact more potent than free Hp91. Hp91 packaged within NPs was about fivefold more potent than the free peptide, and Hp91 conjugated to the surface of NPs was ∼20-fold more potent than free Hp91. Because of their capacity to activate DCs, such NP-Hp91 systems are promising as delivery vehicles for subunit vaccines against infectious disease or cancer. From the Clinical Editor: In this paper, nanoparticle-based dendritic cell activating vaccines are described and discussed. The authors report that the presented PLGA NP based vaccine constructs increase the potency of the studied vaccine by up to 20-fold, making them promising as delivery vehicles for subunit vaccines against infectious diseases or cancer. [ABSTRACT FROM AUTHOR]

Summary: Obesity is associated with insulin resistance in metabolic tissues such as adipose, liver, and muscle, but it is unclear whether nonclassical target tissues, such as those of the reproductive axis, are also insulin resistant. To determine if the reproductive axis maintains insulin sensitivity in obesity in vivo, murine models of diet-induced obesity (DIO) with and without intact insulin signaling in pituitary gonadotrophs were created. Diet-induced obese wild-type female mice (WT DIO) were infertile and experienced a robust increase in luteinizing hormone (LH) after gonadotropin-releasing hormone (GnRH) or insulin stimulation. By contrast, both lean and obese mice with a pituitary-specific knockout of the insulin receptor (PitIRKO) exhibited reproductive competency, indicating that insulin signaling in the pituitary is required for the reproductive impairment seen in DIO and that the gonadotroph maintains insulin sensitivity in a setting of peripheral insulin resistance. [Copyright &y& Elsevier]

Many reports indicate that family member presence in the PACU may decrease anxiety levels in both patients and family members. PACUs, nevertheless, often restrict family visitation because of the close proximity to ORs, complexity, and the fast-paced recovery environment. The purpose of this study was to determine the effect of parental presence on the anxiety levels of children ages 9 to 18, observed behavior of children ages 6 to 8, and reported parental anxiety in the pre- and postoperative periods. The quasi-experimental design used a sample of 72 parent-patient dyads, predominately Hispanic, who completed either the pediatric (9-12) or teenager/adult Speilberger State Anxiety forms. Forty (40) parents were placed in the PACU with their children, and 32 remained in the Waiting Room. PACU nurses coded observations of parents and observations of patients aged 6 to 8 years. FLACC or numeric pain scales scores were also collected. Results showed no difference in parental anxiety between those who were placed in the PACU or Waiting Room. Patients aged 13 to 18 with parents in-PACU had significantly lowered anxiety scores than patients with parents in-Waiting Room (t = 2.51, P = .02). Anxiety scores for younger children (9-12 years old) were not lowered postoperatively regardless of parent placement. Regardless of age, patients with parents in-PACU showed statistically significantly greater pain pre-operatively compared with patients with in-Waiting Room parents (t = 3.15, P = .002), but this difference disappeared postoperatively. [Copyright &y& Elsevier]

Abstract: Knowledge discovery from large and complex scientific data is a challenging task. With the ability to measure and simulate more processes at increasingly finer spatial and temporal scales, the growing number of data dimensions and data objects presents tremendous challenges for effective data analysis and data exploration methods and tools. The combination and close integration of methods from scientific visualization, information visualization, automated data analysis, and other enabling technologies—such as efficient data management—supports knowledge discovery from multi-dimensional scientific data. This paper surveys two distinct applications in developmental biology and accelerator physics, illustrating the effectiveness of the described approach. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this prospective study was to assess whether outcome of speech and language in children 5–10 years after corrective surgery for tetralogy of Fallot (TOF) or ventricular septal defect (VSD) in infancy was influenced by the preoperative condition of hypoxemia or cardiac insufficiency and whether it was associated with perioperative risk factors and neurodevelopmental outcome. A total of 35 unselected children, 19 with TOF and hypoxemia and 16 with VSD and cardiac insufficiency, operated with combined deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass at mean age 0.7±0.3 (mean±standard deviation) years, underwent, at mean age 7.4±1.6 years, standardized evaluation of speech and language functions. Results were compared between subgroups and related to perioperative factors, sociodemographic and neurodevelopmental status. Age at testing, socioeconomic status and history of speech and language development were not different between the subgroups. In contrast, total scores on oral and speech motor control functions (TFS) as well as on oral and speech apraxia (Mayo Test) were significantly reduced (p<0.02 to <0.05), and scores on anatomical oral structures tended to be lower (p<0.09) in the TOF group as compared to the VSD group. No differences were found for auditory word recognition and phonological awareness as assessed by the Auditory Closure subtest of the Illinois Test of Psycholinguistic Abilities and the test of auditory analysis skills, respectively. In all children, higher age at testing and better socioeconomic status were associated with better results in all domains of assessment (p<0.001 to <0.04). Consistent impairments of all oral and speech motor control functions (TFS and Mayo Test) were present in 29% of all children with a mean age of 6.5 years in contrast to 43% with normal performance and a mean age of 8.3 years. On the receptive speech tasks, only 6% scored below the normal range of their age group. TFS subscores were significantly correlated with age, bypass duration and motor function, but not correlated with socioeconomic status, duration of cardiac arrest, intelligence and academic achievement. Children with preoperative hypoxemia due to cyanotic cardiac defects in infancy are at higher risk for dysfunction in speech and language than those with cardiac insufficiency due to acyanotic heart defects. Age at testing, socioeconomic status, and duration of cardiopulmonary bypass influenced test results. Long-term outcome in speech and language functions can be considered as a sensitive indicator of overall child development after cardiac surgery. [Copyright &y& Elsevier]

Summary: The human gland of Moll located at the margin of the eyelids is a specialized apocrine gland, the function of which is not exactly known. The presence of antimicrobial proteins was identified in this gland recently, suggesting a function in the external ocular defense barrier against pathogens. In this study, we have demonstrated β-defensin-1, β-defensin-2 and cathelicidin (LL-37) in the secretory endpieces of the glands of Moll using immunohistochemical methods. β-Defensin-1, β-defensin-2 and cathelicidin (LL-37) showed a weak to moderately intensive staining pattern. The strongest immunolocalization of β-defensin-1 was observed in the apical protrusions of the gland, which could also be observed but to a lesser extent in the case of β-defensin-2 and cathelicidin. In active glandular cells, a granular staining pattern could be observed. β-Defensin-1 and β-defensin-2 varied in staining intensities, and even within one section strongly and weakly stained cells can coexist side by side. Also cells that, according to morphological criteria, appeared to be inactive still had an apical β-defensin-1 immunolabeling. We assume that β-defensin-1, β-defensin-2 and cathelicidin (LL-37) work together with other antimicrobial peptides and proteins to create a defensive barrier against microbial invasion at the ocular surface. [Copyright &y& Elsevier]

Summary: Background: Surgical navigation requires registration of the pre-operative image dataset with the patient in the operation theatre. Various marker and marker-free registration techniques are available, each bearing an individual level of precision and clinical practicability. In this study the precision of four different registration methods in a maxillofacial surgical setting is analyzed. Materials and methods: A synthetic full size human skull model was registered with its computer tomography-dataset using (a) a dentally mounted occlusal splint, (b) the laser surface scanning, (c) five facial bone implants and (d) a combination of dental splint and two orbital bone implants. The target registration error was computed for 170 landmarks spread over the entire viscero- and neurocranium in 10 repeats using the VectorVision2® (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical analyses were performed by anatomical region. Results: An average precision of 1mm was found for the periorbital region irrespective of registration method (range 0.6–1.1mm). Beyond the mid-face, precision linearly decreases with the distance from the reference markers. The combination of splint with two orbital bone markers significantly improved precision from 1.3 to 0.8mm (p <0.001) on the viscerocranium and 2.3–1.2mm (p <0.001) on the neurocranium. Conclusions: An occlusal splint alone yields poor precision for navigation beyond the mid-face. The precision can be increased by combining an occlusal splint with just two bone implants inserted percutaneously on the lateral orbital rim of each side. [Copyright &y& Elsevier]

Background: Attentional dysfunction in children after corrective cardiac surgery in infancy has rarely been evaluated and is the topic of the present work. Methods: Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on at a mean age 0.7 (SD 0.3) years with deep hypothermic circulatory arrest and low flow cardiopulmonary bypass, were evaluated at mean age 7.4 (SD 1.6) years by the computerized form of the Attention Network Test providing performance measures of three networks of attention: alerting, orienting, and executive control. Parental ratings of attentional dysfunction were derived from the Child Behavior Checklist. Results were compared with healthy controls, between patient groups, and correlated with perioperative risk factors and current neurodevelopmental status. Results: Executive control was reduced in the tetralogy of Fallot group, alerting and orienting were found normal and not different between patient groups. Durations of aortic cross clamping inversely correlated with orienting; durations of cardiopulmonary bypass correlated with mean reaction time and inversely correlated with executive control. Motor function and acquired abilities correlated with executive control and orienting. Parent-reported problems on the Child Behavior Checklist inversely correlated with executive control and mean accuracy. Conclusions: Children with preoperative hypoxemia in infancy due to cyanotic cardiac defects are at increased risk for attentional dysfunction in the field of executive control, compared with normal children and with those who have acyanotic heart defects. Besides unfavorable perioperative influences, preoperative hypoxemia is considered responsible for additional damage to the highly oxygen sensitive regions of the prefrontal cortex and striate body assumed to be associated with the executive control network of attention. [Copyright &y& Elsevier]

Background: The purpose of this prospective study was to assess whether neurodevelopmental status and exercise capacity of children 5 to 10 years after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy was different compared with normal children and influenced by the preoperative condition of hypoxemia or cardiac insufficiency. Methods: Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass at a mean age of 0.7 ± 0.3 years (mean ± SD), underwent, at mean age 7.4 ± 1.6 years, standardized evaluation of neurologic status, gross motor function, intelligence, academic achievement, language, and exercise capacity. Results were compared between the groups and related to preoperative, perioperative, and postoperative status and management. Results: Rate of mild neurologic dysfunction was increased compared with normal children, but not different between the groups. Exercise capacity and socioeconomic status were not different compared with normal children and between the groups. Compared with the normal population, motor function, formal intelligence, academic achievement, and expressive and receptive language were significantly reduced (p < 0.01 to p < 0.001) in the whole group and in the subgroups, except for normal intelligence in ventricular septal defect patients. Motor dysfunction was significantly higher in the Fallot group compared with the ventricular septal defect group (p < 0.01) and correlated with neurologic dysfunction, lower intelligence, and reduced expressive language (p < 0.05 each). Reduced New York Heart Association functional class was correlated with lower exercise capacity and longer duration of cardiopulmonary bypass (p < 0.05 each). Reduced socioeconomic status significantly influenced dysfunction in formal intelligence (p < 0.01) and academic achievement (p < 0.05). Preoperative risk factors such as prenatal hypoxia, perinatal asphyxia, and preterm birth, factors of perioperative management such as cardiac arrest, lowest nasopharyngeal temperature, and age at surgery, and postoperative risk factors as postoperative cardiocirculatory insufficiency and duration of mechanical ventilation were not different between the groups and had no influence on outcome. Degree of hypoxemia in Fallot patients and degree of cardiac insufficiency in ventricular septal defect patients did not influence the outcome within the subgroups. Conclusions: Children with preoperative hypoxemia in infancy are at higher risk for motor dysfunction than children with cardiac insufficiency. Corrective surgery in infancy for tetralogy of Fallot or ventricular septal defect with combined circulatory arrest and low flow bypass is associated with reduced neurodevelopmental outcome, but not with reduced exercise capacity in childhood. In our experience, the general risk of long-term neurodevelopmental impairment is related to unfavorable effects of the global perioperative management. Socioeconomic status influences cognitive capabilities. [Copyright &y& Elsevier]

Background: The development of hypertensive pulmonary vascular disease (HPVD) is considered a risk factor in the long-term course of patients with secundum atrial septal defects (ASD). The aim of this study was to assess the prevalence and histologic degree of HPVD and pulmonary hypertension in relation to preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome in adults. Methods: Lung biopsies of 75 patients, mean age 44 ± 14 years (18–71 years), with secundum ASD or sinus venosus defect including ten patients with partial anomalous pulmonary venous return were analyzed in accordance with preoperative and intraoperative findings as well as operative outcome. Lung biopsy was performed at the time of defect closure and was classified according to Heath and Edwards. Results: Structural changes of the pulmonary vasculature were found in 59% of patients; grade 3 and higher changes were present in 19%. There were no statistically significant relations between histologic findings and preoperative clinical and hemodynamic data, intraoperative findings, and operative outcome. The prevalence of moderate (32–50 mm Hg) and severe (> 50 mm Hg) systolic pulmonary hypertension was 27% and 17%, respectively. Increased systolic pulmonary arterial pressure was associated with increased pulmonary vascular resistance (p < 0.000) and patients′ age (p = 0.001). Patients with a lower functional capacity had a higher prevalence of pulmonary hypertension (p = 0.011). Conclusions: The prevalence of HPVD and pulmonary hypertension in adult patients with secundum ASD or sinus venosus defect is considerable. Preoperative hemodynamic data do not predict the degree of HPVD in lung biopsy. Closure is generally advised to prevent increasing pulmonary arterial pressure and decreasing functional capacity over time. [Copyright &y& Elsevier]

Nurse educators are constantly seeking opportunities to expose undergraduate students to different cultures. This requirement is essential to prepare tomorrow''s nursing professionals to practice culturally component care in diverse health care environments. This article describes a unique collaborative experience between the University of Pittsburgh School of Nursing and the Miami Children''s Hospital that offers senior baccalaureate students the opportunity to complete one term of clinical experience in a culturally diverse health care facility. [Copyright &y& Elsevier]

: BackgroundThe purpose of this study was to assess cardiac and general health status 8 to 14 years after neonatal arterial switch operation for transposition of the great arteries.: MethodsSixty unselected children with intact ventricular septum (78.3%) or ventricular septal defect (21.7%) without or with aortic isthmic stenosis (5.1%) were examined 10.5 ± 1.6 (mean ± SD) years after neonatal switch and 5.3 ± 1.6 years after mid-term evaluation. Complete clinical examination, standard and 24-hour Holter electrocardiogram, M-mode, 2D-, Doppler, and color Doppler echocardiography were performed. Results were compared with normal values and to mid-term follow-up results.: ResultsRates of reoperation after arterial switch operation and operation to correct concomitant coarctation were 3.3% and 5.1%, respectively. No patient needed medication, and 93.3% had no limitation of physical activity. All children had normal height and weight; 31.6% had abnormal thoracic configuration after median sternotomy. Most patients (91.7%) were in sinus rhythm. Incidence of complete right bundle branch block (10.0%) was unchanged, as was prevalence of ectopic activity (occasional atrial ectopy 20.0%, ventricular ectopy: occasional 21.7%; frequent 1.7%). Left ventricular dimensions and shortening fraction did not change over time. Diameters of neo-aortic valve annulus and neo-aortic root did not increase, and z-scores decreased between mid-term and present evaluation. Incidence of neo-aortic insufficiency was 13.3% and remained unchanged in comparison with the pre-examination value. Neo-aortic stenosis was not seen. Compared with mid-term follow-up, incidence (41.6%) and degree of supravalvular pulmonary stenosis increased.: ConclusionsGood cardiac results persist 10 years after neonatal arterial switch operation for transposition of the great arteries. Encouraging findings include preservation of left ventricular function, low incidence of rhythm disturbances, lack of further neo-aortic root dilatation, and unchanged incidence of neo-aortic insufficiency compared with mid-term follow-up. Increased incidence and degree of supravalvular pulmonary stenosis are of concern. [Copyright &y& Elsevier]

Background. Although patients after Fontan procedure have a high incidence of thromboembolic complications, anticoagulant therapy is not handled uniformly. We analyzed the frequency and clinical relevance of thromboembolism after Fontan procedure and compared different therapeutic approaches.Methods. From 1986 to 1998, 101 patients (mean age, 7.3 ± 8.1 years) underwent Fontan type procedure (modified Fontan, n = 40; total cavopulmonary connection, n = 61). In 85 of 87 survivors, transthoracic echocardiography was performed; and in 31 transesophageal echocardiography and/or angiography was performed. Mean follow-up was 5.7 ± 3.5 years. Three groups with different anticoagulant regimen were compared: group I without medication (n = 45), group II with acetylsalicylic acid therapy (n = 14) and group III with Coumadin (n = 26).Results. Thromboembolic events occurred in 13 of 85 patients (15.3%; 3.3 events/100 patient-years). Type of operation as well as other known risk factors had no influence on the rate of thromboembolism. Within the first postoperative year, seven of 13 events occurred. A second peak developed beyond 10 years of follow-up. Patients benefit significantly from Coumadin compared with those who did not receive any medication, with similar results in the entire population and the subgroup of patients with total cavopulmonary connection (log-rank, p = 0.031 and p = 0.033, respectively). With 4.2 events/100 patient-years, the cumulative event rate was substantially higher in group I than with 1.6 in group II and with 1.1 in group III. No relevant bleeding complications occurred.Conclusions. Thromboembolism is frequent after Fontan procedure, with a peak during the first postoperative year and another peak beyond 10 years of follow-up. Coumadin is the most effective prophylactic therapy in preventing thromboembolism. Therefore, we suggest initial oral anticoagulation therapy in patients with Fontan type operation. [Copyright &y& Elsevier]

Background. The control of the systemic inflammatory response taking place during cardiac operations depends on adequate antiinflammatory reaction. In this prospective study we tested the hypothesis that cytokine balance during pediatric cardiac surgical procedures would be influenced by the patients’ preoperative clinical condition, defined as hypoxemia or heart failure.Methods. Twenty infants (median age, 8 months) with hypoxemia owing to intracardiac right-to-left shunt (group 1, n = 10) or with heart failure because of intracardiac left-to-right shunt (group 2, n = 10), scheduled for elective primary corrective operation, were enrolled. Plasma levels of the proinflammatory cytokine interleukin (IL) 6, the natural antiinflammatory cytokine IL-10, and the markers of the acute-phase response, C-reactive protein and procalcitonin, were sequentially measured before, during, and after cardiac operation up to the 10th postoperative day. The ratio of IL-10 to IL-6 levels served as a marker for the individual’s antiinflammatory cytokine balance.Results. Group 1 showed higher preoperative IL-6 (p < 0.001), lower IL-10 levels (p < 0.02), and lower ratio of IL-10 to IL-6 levels (p < 0.001) than group 2. Preoperative C-reactive protein and procalcitonin were not detectable. In group 1, preoperative IL-6 levels inversely correlated with preoperative oxygen saturation (Spearman correlation coefficient, −0.74, p < 0.02). During cardiopulmonary bypass, IL-6 levels were higher, whereas IL-10 and ratio of IL-10 to IL-6 levels were lower in group 1 than in group 2. In all patients, postoperative IL-6 levels were positively correlated with duration of inotropic support and serum creatinine value and inversely correlated with oxygenation index and diuresis.Conclusions. Infants with hypoxemia show a preoperative inflammatory state with low antiinflammatory cytokine balance in contrast to those with heart failure. This in turn is associated with lower perioperative antiinflammatory cytokine balance and might contribute to postoperative morbidity. [Copyright &y& Elsevier]

Background. To assess incidence, etiology, and clinical relevance of common peroneal nerve injury (CPNI) in patients after cardiothoracic surgery.Methods. In an 11-year period, CPNI was detected in 39 out of 20,718 patients (0.19%): 38 times after cardiopulmonary bypass (CPB) (38 of 12,726; 0.30%) and in 1 patient after a non-CPB procedure (1 of 7,992; 0.013%). These patients underwent intensive physiotherapeutic treatment. As the majority of CPNI occurred after CPB (97.4%), data of these patients were compared with a 1-year set of 1,032 patients who underwent CPB procedures.Results. Patients with CPNI were older, had a higher percentage of subnormal body weight, and had considerable comorbidity such as peripheral arteriosclerotic disease, diabetes mellitus, and arrhythmias. Follow-up was complete (mean: 5.2 years; 0.4 to 10.7 years). Twenty-eight patients were free of symptoms; 10 patients complained of moderate symptoms, but were not limited in their everyday life; 1 patient still suffers from severe sensorimotor symptoms.Conclusions. CPNI after cardiothoracic surgery is rare. Duration of the operative procedure, an increased comorbidity, and a subnormal body weight are assumed to have an etiologic impact. Prognosis is mostly good, but early physiotherapeutic treatment is crucial for prognosis. [Copyright &y& Elsevier]

We evaluated the long-term morphologic and clinical outcomes after thoracic endovascular aortic repair combined with parallel grafts (PG-TEVAR) for arch-involving aortic pathologies. We performed a retrospective analysis of perioperative and follow-up data of patients who had undergone PG-TEVAR at a single vascular surgery center from November 2010 to April 2018. Patients with prior or simultaneous open chest or cervical debranching procedures or arch repair were excluded. The primary endpoint was freedom from overall PG-TEVAR–related reintervention. The secondary endpoints were parallel graft sealing zone failure (presence of gutter-related type I or Ic endoleak), PG failure (occlusion or reintervention), stroke, and 30-day and overall PG-TEVAR–related and all-cause mortality. Kaplan-Meier curves were used to estimate the freedom from reintervention and survival. Receiver operating characteristics curves were used to find the optimal cutoff to prevent type Ia endoleak-related reintervention. A total of 33 patients, including 8 women, with a median age of 74 years (interquartile range, 67-79 years) had undergone PG-TEVAR (chimney, periscope, and sandwich in 20, 15, and 13 patients, respectively) with proximal landing in Ishimaru zone 0, 1, or 2 in 4, 5, and 24 patients, respectively. The aortic pathologies included type B aortic dissection (acute and chronic, eight and six, respectively), degenerative aneurysm (n = 10), type Ia endoleak (n = 3), para-anastomotic/patch aneurysm (n = 4), left subclavian artery aneurysm (n = 1), and traumatic rupture (n = 1). The perioperative stroke rate and 30-day mortality was 6% and 9%, respectively. Direct postoperative computed tomography revealed 28 endoleaks (gutter-related type Ia, 12; gutter-related type Ib, 9; type Ia, 2; type Ic, 2; type III, 1; undetermined, 2) in 27 patients. The technical and clinical success rate was 37% and 30%, respectively. The mean follow-up for survival was 48 ± 31 months. The latest radiologic follow-up demonstrated 12 remaining and 1 new endoleak. The early and overall PG sealing zone failure and PG failure was 73% and 36% and 9% and 18%, respectively. The overall PG-TEVAR–related reintervention rate was 33% (n = 11). The estimated freedom from overall PG-TEVAR–related reintervention was 68% at 60 months. The main graft oversizing and length oversizing rates were not significantly associated statistically with the type Ia endoleak-related reintervention rate. The PG-TEVAR–related and all-cause mortality were 18% and 34%, respectively. PG-TEVAR for total endovascular repair of arch-involving aortic pathologies resulted in a high rate of type I endoleaks and the need for long-term reintervention. Gutter-related endoleaks might be more frequent than reported and should not be underestimated because they can lead to sac enlargement and reintervention. Frequent radiologic surveillance is mandatory. Further studies comparing PG-TEVAR to other total endovascular alternatives are required to confirm these findings. [ABSTRACT FROM AUTHOR]

• People with MS are a heterogeneous population with varying difficulties and needs. • 83% of the sample reported at least one unmet health or social care-related need. • A higher number of health and social care-related unmet needs predicts lower HRQoL. • Clinical and socio-demographic variables are significant predictors of HRQoL. People with MS are a heterogeneous population with varying difficulties and needs that are influenced by the individual experience of the disease, symptoms and disease course. The aim of the present study was to identify factors that influence health-related quality of life in a sample of subjects with MS, specifically health and social care-related needs and demographic and disease characteristics. Individuals with a definite diagnosis of MS were identified through MS out-patient clinics and local branches of the Italian MS Society. The EQ-5D-3L utility index was used to describe health profiles and as an overall measure of perceived HRQoL. The number of unmet health and social care-related needs was used to describe the impact of unmet needs on HRQoL. Multiple regression analyses were performed using a hierarchical approach. Data was analyzed from 1013 subjects. Overall, 83% of subjects reported at least one health or social care-related need as being unmet and subjects with a higher number of unmet needs had lower HRQoL (p < 0.001). The number of unmet needs was entered at the first step with a statistically significant effect (Cox-Snell R2 0.15, BIC 870.9, AIC 851.2). Clinical variables, included in the second step, contributed significantly to explaining the variability between models (Cox-Snell R2 0.43, BIC 481.0, AIC 446.6), and the addition of socio-demographic factors further accounted for variability (Cox-Snell R2, 0.46, BIC 461.0, AIC 402.0). The study demonstrated that a higher number of both health and social care-related unmet needs predicted lower HRQoL. The health profile of the sample identified all domains of the EQ-5D-3L as being important in determining HRQoL. Data confirms that unmet needs alone are significantly related to reduced HRQoL, although the multifactorial and complex nature of MS makes it a challenge to identify the combination of aspects that fully predict variability in quality of life. [ABSTRACT FROM AUTHOR]