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We have investigated the contribution of the Higher Twist (HT) Feynman diagrams to the large-$p_T$ inclusive $\rho_L$ meson production cross section in proton-proton and proton-antiproton collisions and we discuss the phenomenological consequences of possible HT contributions to cross sections. To extract HT subprocesses from Leading Twist (LT) background, we use various $\rho_L$ meson distribution amplitudes(DAs). In the numerical calculations, the dependencies of the HT contribution on the transverse momentum and the rapidity are discussed with special emphasis on DAs. Analysis of our results shows that HT contributions decrease more rapidly than LT contributions with increasing $p_T$. The preceding results demonstrate that HT contributions must be considered especially in the region of low $p_T$ and the HT contribution to the cross-section depends on the choice of the meson distribution amplitudes., Comment: 21 pages, 11 figures. arXiv admin note: text overlap with arXiv:1903.00890

BackgroundExercise can be beneficial to cardiovascular system function, but its influence during pregnancy is less well understood. Heterogeneity in research studies has led to a lack of consensus on whether physical exercise during pregnancy can elicit cardiovascular adaptations during a period in which the cardiovascular system is already being challenged. Furthermore, little research has been conducted regarding the influence of physical exercise on foetal heart rate (FHR). This paper presents the protocol for a randomised controlled trial which will evaluate the influence of supervised antenatal physical exercise on cardiovascular adaptations during and after pregnancy, as well as the FHR response to acute and chronic maternal exercise.MethodsThe PE-CAMP Study (Physical Exercise and Cardiovascular Adaptation Monitoring in Pregnancy) is a randomised controlled trial (RCT) in which pregnant women will be randomised into an intervention group (INT), which attended supervised physical exercise programme up to three days per week, or a comparison group (COMP) which followed standard health care. All participants were assessed at three time-points i) 18-22 weeks pregnant, time-point 1; ii) 33-37 weeks pregnant, time-point 2; and iii) 12-16 weeks postnatal, time-point 3. A standardised experimental protocol was used for data collection, including body composition assessment, upper-body flexibility and strength assessment, physical activity assessment via questionnaires and acceletometry, and haemodynamic and cardiovascular evaluation before, during and after an acute 10-minute exercise bout. Foetal heart rate will be assessed at the time-point 2 before, during and after acute exercise.DiscussionAlthough it is necessary and informative to continue investigating the effects of exercise on maternal cardiac and haemodynamic responses using specific laboratory-based tests, it is also critical to evaluate these influences during activities that are more achievable and realistic for pregnant women. The PE-CAMP study will provide data on the cardiac and haemodynamic responses to a typical acute bout of exercise, which could help inform future decisions and policies on maternal exercise prescription made by maternity healthcare providers and exercise professionals.Clinical Trials Registration NumberNCT03748888

Background Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group are unknown. Purpose To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM. Methods Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children ( Results 96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11–16, range 3–16) and weight 52.3 kg (IQR 34.8–63.1). Indication for ICD was primary prevention in 72 (75%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=66, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied: all had VF therapies activated (median 220bpm, IQR 212–230); 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9), of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4), 4 patients (4.2%) died following arrhythmic events despite a functioning device. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5–7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value Conclusions In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications. Funding Acknowledgement Type of funding source: Other. Main funding source(s): British Heart Foundation

This article discusses and analyzes the emergency situations resulting the use of the natural and the liquefied gas in the northern areas. The normative and the technical documentation concerning the items of the control and the supervision in the gas facilities is analyzed here. It is concluded that in present there is no unified service which effectuates the control of the technical state of the gas equipment in the residential houses. That is why it is observed the use of the gas equipment of the high degree of the deterioration and not perfect technically. The equipment is missing of the systems of the control of the gas leaks and of the gas contamination in the room, there is no of the automatic shutdown of the gas supply in the emergency situations. There are a lot of violations during the use of the liquefied gas in the cylinders during the filling of the cylinders by gas. During the exploitation of the liquefied gas in the cylinders especially in non-stationary conditions in result of the not observation of the technological conditions of the safety, the decompression of the cylinders takes place and with the subsequent explosion. According to the results of the analysis of the state of the item the offers are developed concerning the increasing of the security level of the exploitation of the gas networks and of the use of the liquefied gas in the cylinders, and also of the housekeeping equipment working on gas. In the legal form, it is recommended that the functions of monitoring the state of gas equipment and networks be transferred to one organization with the rights of state supervision. Ensuring operational reliability - condition monitoring, preventive and routine repairs, replacement of equipment, it is also advisable to transfer one specialized organization. Contractual relations with these organizations must be transferred to management companies. In the technical field of safety, it is necessary to replace outdated thermal equipment with modern models with gas monitoring of gas leakage and gas burner operation. These recommendations also apply to metal cylinders for liquefied gases that need to be replaced with more reliable cylinders with a composite shell. It is necessary to diversify and improve preventive work to educate the population about safe handling of gas equipment and rules of conduct in case of emergency events with gas equipment.

Background: Deteriorated speech understanding is a common complaint in elderly people, and behavioraltests are used for routine clinical assessment of this problem. Cortical auditory evoked potentials(CAEPs) are frequently used for assessing speech detection and discrimination abilities of the elderly,and give promise for differential diagnosis of speech-understanding problems.Purpose: The aim of the study was to compare the P1, N1, and P2 CAEP latencies and amplitudes inpresbycusis with low and high word recognition score (WRS).Research Design: A cross-sectional study design was used for the study. Two groups were formed fromthe patients with presbycusis based on their scores on the speech-recognition test.Study Sample: Fifty-seven elderly volunteers participated in the study. The first group composed of 27participants with high WRS, the other group composed of 30 participants with low WRS.Data Collection and Analysis: The CAEP waves were recorded from these participants using speech signals.Latencies and amplitudes of P1-N1-P2 waves of the two groups were compared with the t-test statistic.Results: There were significant prolongation of P1 and N1 latencies in presbycusis with low WRS whencompared with presbycusis with a relatively high word score (p < 0.05).Conclusion: According to the result of the research, P1 and N1 latencies of presbycusis with low WRSwere longer than the participants with high WRS. Factors affecting peripheral auditory system, such asstimulus sensation level, might be responsible for P1 and N1 latency prolongation of the low WRS group.

Purpose Medium- and long-term data for the outcomes of balloon pulmonary valvuloplasty (BPV) as a treatment for isolated pulmonary valve stenosis (PS) are lacking. Methods Patients with valvular PS who underwent BPV between 1997 and 2017 were identified from the cardiac database. Echocardiographic reports, procedural information and clinic letters were reviewed. Results 72 patients were identified. The average length of follow-up was 8.4 years. Freedom of reintervention following BPV was 82% and 80% at 5- and 10 years respectively. 83% of reinterventions were due to residual severe PS. At both medium- and long-term follow up the incidence of moderate pulmonary regurgitation (PR) was significantly increased (p Conclusion BPV is a safe and effective procedure for treating severe PS. PR is a common outcome of BPV but is well tolerated.

Balbay, Ege Gulec/0000-0002-1557-7019 WOS: 000330777900007 PubMed: 23157213 The purpose of this study was to examine the effects of hypobaric hypoxia on testis morphology and the effects of erdosteine on testis tissue. Caspase-3 and hypoxia-inducible factor 1 expressions were detected by immunohistochemistry. Adult male Wistar rats were placed in a hypobaric hypoxic chamber. Rats in the erdosteine group were exposed to the same conditions and treated orally with erdosteine (20mgkg(-1) daily) at the same time from the first day of hypoxic exposure for 2weeks. The normoxia group was evaluated as the control. The hypoxia group showed decreased height of spermatogenic epithelium in some seminiferous tubules, vacuolisation in spermatogenic epithelial cells, deterioration and gaps in the basal membrane and an increase in blood vessels in the interstitial area. The erdosteine group showed amelioration of both epithelial cell vacuolisation and basal membrane deterioration. Numbers of hypoxia-inducible factor 1-immunostained Sertoli and Leydig cells were significantly higher in the hypoxia group than in the erdosteine group. The number of seminiferous tubules with caspase-3-immunostained germ cells was highest in the hypoxia group and decreased in the erdosteine and normoxia groups respectively. Based on these observations, erdosteine protects testis tissue from hypoxic injury by reducing apoptotic cell death.

Objectives To investigate whether prenatal screening is effective in the detection of total anomalous pulmonary venous connection (TAPVC) and to identify common prenatal features. Methods This was a retrospective collaborative study involving 19 pediatric cardiac centers in the UK, Ireland and Sweden. Cases with TAPVC born between January 1, 1998 and December 31, 2004, and prenatally diagnosed cases whose estimated dates of delivery were within this time frame, were identified. Cases with functionally univentricular circulation or atrial isomerism were excluded. All available data and stored images were reviewed. Results Four-hundred and twenty-four cases with TAPVC were identified prenatally or postnatally, of whom eight (1.9%) had a prenatal diagnosis of TAPVC. Median gestational age at fetal diagnosis was 26 + 6 (range, 22 + 4t o 32+ 0) weeks. Six further fetuses with TAPVC had an abnormality diagnosed on prenatal ultrasound, but not the TAPVC. This included other congenital heart defects (four cases) and isolated pleural effusion (two cases). Seventeen (4.0%) of the 422 liveborn infants had a first-degree relative with congenital heart disease; and six of 17 had a sibling with TAPVC. Two died in utero .O f the liveborn infants diagnosed prenatally with TAPVC, none required urgent intervention for pulmonary venous obstruction and all were alive and well at a median of 2.3 (range, 1.0–7.0) years after surgical repair. Conclusion Prenatal diagnosis of TAPVC is infrequent using current screening methods. Where there is a family history of TAPVC, specialized fetal echocardiography at 20 and 28 weeks’ gestation may be indicated. Copyright  2012 ISUOG. Published by John Wiley & Sons, Ltd.

In this study the relationship among mathematics anxiety, mathematics attitude, and mathematics success of the Faculty of Economics and Business Administration students were examined. The sample of the study included 1440 students from the Business Administration, Economics and Finance departments of nine universities in Turkey. The ‘Math Anxiety Scale’ and ‘Math Attitude Scale’ instruments were used. Demographic information form which was prepared by the authors of this paper was also used. The variance analysis, chi-square, independent samples, t test techniques were used for statistical analyses. According to the results of the analyses, there is no relationship between the level of mathematics anxiety and gender, but the level of mathematics anxiety, department, class, mathematics success and general academic success are related. The Finance department students have higher level of mathematics anxiety than the others. While the mathematics success is decreasing, the level of mathematics anxiety is increasing. However, while the level of mathematics anxiety is increasing, the general academic success is also increasing. Finally, we presented some special strategies for studying mathematics, doing homework, and taking exams in an aim to avoid from the math anxiety.

Bu çalışmada, kuvvet-yerdegiştirme grafiklerinin altındaki alandan hareketle sertlik hesaplamasını yapabilmek üzere, matematiksel bir model geliştirilmiştir. Bu metod, özellikle, yumuşak numunelerde kuvvet-yüzey etkileşmesinde ortaya çıkan ve hesaplamaları ciddi şekilde etkileyen yüzey egilmeleri sıkıntısını ortadan kaldırmakta ve gerçeğe daha yakın sertlik degerleri vermektedir.

Rational use of antimicrobials is a key element for a successful strategy against development of resistance to antimicrobials. The physician should establish the need and the reason for therapy, select the appropriate antimicrobial agent, and then decide on the optimum dose and dosing interval, duration, as well as route of administration. In a particular hospital, the present status of antimicrobial use should be determined, and a strategy should be developed to improve it. This usually encompasses a combination of educative, facilitative and restrictive measures. Good infection control practice is a critical component for success of such a programme.

Background Hematogenous candidiasis is associated with a substantial mortality and morbidity in critically ill patients. Candidemia is the best marker for hematogenous infection; therefore, most studies have examined the outcome of candidemia. However, few have focused on the predictors of outcome in cancer patients with candidemia. Materials and methods We conducted a MEDLINE search for all study reports published from 1974 to 1999 on candidemia and prognostic factors including predictors of mortality. Ten articles that provided sufficient data were evaluated in detail. Results The overall mortality rate was reported to be 33%–75%. Univariate analyses identified severity of underlying disease, performance status, neutropenia, Candida species, source of candidemia and the extent of visceral involvement as important prognostic variables. In multivariate analyses, however, only host factors and extent of infection (rather than infecting Candida species) were predictive of mortality. Conclusions Older age, poor performance status, presence and persistence of neutropenia, and extensive organ involvement with candidiasis are the most important prognostic factors for candidemia in cancer patients.

In November 1995, an increase was noticed in the number of methicillin-resistant Staphylococcus aureus (MRSA) isolates from a surgical ward at Hacettepe University Hospital. All MRSA isolates obtained from clinical specimens in this ward (14 MRSA isolates from wound cultures of 10 patients) were collected prospectively for 10 weeks. Surveillance cultures were taken from ward personnel (nose cultures from 4 physicians, 7 nurses, 1 secretary, 1 waiter), 2 surgical dressing containers and 1 nebulizer. MRSA was isolated from one of the surgical dressing containers, the nebulizer and nose cultures of 3 physicians, 3 nurses and the ward secretary. Arbitrarily primed polymerase chain reaction (AP-PCR) analysis showed that most MRSA isolates belonged to 2 major clones (pattern A, pattern B). Pattern A was the most frequent one and was present in 4 clinical isolates, surgical dressing container-1. Pattern B was identified in 3 clinical isolates and nose culture of physician-3. AP-PCR analysis revealed that this mini-MRSA outbreak was caused by contamination of surgical dressing container with MRSA and nasal MRSA carriage in ward staff. AP-PCR seems to be a valuable typing method for analysis of nosocomial MRSA outbreaks because of its simplicity and rapidity.

BACKGROUND: Many factors, including severity of illness, neutropenia, intravenous catheter management, and drug therapy may affect the outcome of candidemia in cancer patients. METHODS: The records of all patients at M. D. Anderson Cancer Center who developed one or more positive blood cultures for Candida spp between January 1, 1988, and December 31, 1992, were retrospectively reviewed. Four hundred ninety-one episodes of candidemia were identified, for which 476 had complete medical records, which were reviewed in detail. RESULTS: By 3-month follow-up, 52% of the patients had died. Neutropenia, higher APACHE III score, and visceral dissemination were associated with poor prognosis. Cure rates, adjusted for severity of illness, were similar for fluconazole and amphotericin B treatment. Exchange of central venous catheters was associated with a modest improvement in prognosis. CONCLUSION: Several factors that influence the outcome of candidemia in cancer patients have been identified. These factors may be relevant for the clinical management of cancer patients with candidemia, and for the design of therapeutic trials.

This study proposes a probabilistic approach to evaluate prenatal risk of Down syndrome. In this study, we address the decision-making problem in diagnosing Down syndrome from the machine learning perspective aiming to decrease invasive tests. We employ Naive Bayes and Bayesian Networks classification algorithms as probabilistic methods. This probabilistic classification approach is one of the leading work in medical domain. We use George Washington University dataset in our study. We also benchmark our probabilistic classifiers with widely used non-probabilistic classifiers in machine learning literature. Finally the results of the experiments show that probabilistic classifiers enable acceptable prediction of Trisomy 21 case and the classification performance can be improved by using the proposed techniques in this study.

Radiocesium (134Cs and 137Cs) activity levels in lichen samples from the eastern Black Sea area in Turkey are reported about seven years after the Chernobyl accident. The level of total cesium activity counted in the samples collected from the coastal area in east part of Rize city proved that this region was affected by Chernobyl to a higher degree compared with most European countries.

Moss samples collected from the eastern Black Sea about 6.5 years after the Chernobyl accident have been analyzed for radiocesium activity.134Cs activity was also detected in all the samples beside137Cs radionuclide. The levels of total cesium activity in the mosses proved that the coastal zone in the eastern Black Sea region was highly contaminated.

Fluconazole has proved to be effective in treating oropharyngeal and esophageal candidiasis in immunocompromised patients. However, sufficient data are lacking regarding the efficacy of this agent in neutropenic hosts. The aim of the present study was to determine the clinical and mycological efficacy of fluconazole and to define the factor(s) affecting the outcome of fluconazole therapy in severely neutropenic patients (peripheral neutrophil count, < 500/microL) with cancer who have oropharyngeal and/or esophageal candidiasis. One hundred eleven patients with 129 episodes of candidal infections were treated with intravenous and consequently oral fluconazole (200 mg/d and 100 mg/d, respectively). Overall clinical cure and mycological eradication rates were 82% and 56%, respectively. Persistent neutropenia (P < .01), infection with a non-albicans strain of Candida (P = .012), and administration of antifungal therapy during the second or a later neutropenic episode (P < .002) were independently associated with a worse outcome. We conclude that fluconazole is effective in the treatment of upper gastrointestinal candidiasis in neutropenic patients with cancer. Effective treatment of the underlying malignancy, with the resultant recovery from neutropenia, and the determination of the species of infecting Candida isolates are required for the prediction of the outcome of antifungal therapy.

To investigate whether prenatal screening is effective in the detection of total anomalous pulmonary venous connection (TAPVC) and to identify common prenatal features.This was a retrospective collaborative study involving 19 pediatric cardiac centers in the UK, Ireland and Sweden. Cases with TAPVC born between January 1, 1998 and December 31, 2004, and prenatally diagnosed cases whose estimated dates of delivery were within this time frame, were identified. Cases with functionally univentricular circulation or atrial isomerism were excluded. All available data and stored images were reviewed.Four-hundred and twenty-four cases with TAPVC were identified prenatally or postnatally, of whom eight (1.9%) had a prenatal diagnosis of TAPVC. Median gestational age at fetal diagnosis was 26 + 6 (range, 22 + 4 to 32 + 0) weeks. Six further fetuses with TAPVC had an abnormality diagnosed on prenatal ultrasound, but not the TAPVC. This included other congenital heart defects (four cases) and isolated pleural effusion (two cases). Seventeen (4.0%) of the 422 liveborn infants had a first-degree relative with congenital heart disease; and six of 17 had a sibling with TAPVC. Two died in utero. Of the liveborn infants diagnosed prenatally with TAPVC, none required urgent intervention for pulmonary venous obstruction and all were alive and well at a median of 2.3 (range, 1.0-7.0) years after surgical repair.Prenatal diagnosis of TAPVC is infrequent using current screening methods. Where there is a family history of TAPVC, specialized fetal echocardiography at 20 and 28 weeks' gestation may be indicated.

WOS: 000307361100006 Behcet's disease (BD) is an inflammatory disorder characterised by a triad of recurrent oral and genital ulcers with relapsing uveitis. There is a predilection of young male patients for pulmonary involvement in BD. Pulmonary artery aneurysm (PAA) and pulmonary artery thrombosis without aneurysm are the most frequent types of pulmonary involvement in BD.Thrombi within PAA is common. Death usually occurs due to massive haemoptysis in patients with PAA. Immunosuppresion is the main therapy for pulmonary vasculitis in BD. Takayasu's arteritis (TA) is a chronic inflammatory disease of medium-and large-sized arteries that commonly affects the aorta, its main branches and to a lesser extent the pulmonary arteries. TA is most common in young females in their second and third decades of life, and affects them approximately 10 times more often than males. Granulomatous inflammation most commonly involves the aorta and its major branches, and symptoms result from the stenosis, occlusion and aneurysm of involved arteries. Pulmonary artery involvement is nearly always associated with the involvement of the aorta or its branches. Immunosuppresion, with or without surgery, constitute the main treatment options in TA.

The aims of this study were to evaluate possible relationships between trait anxiety, dental anxiety and the total number of decayed, missing and filled teeth (DMFT) index of patients attending a dental school clinic. A sample of 558 patients was surveyed with the Turkish version of the Spielberger Trait Anxiety Inventory and Dental Anxiety Scale. DMFT index was calculated by clinical and radiographic examination. A significant linear correlation was observed between trait and dental anxiety, but there was no correlation between DMFT index, trait anxiety and dental anxiety. Trait anxiety has an impact on dental anxiety, but does not affect the DMFT index.

A total of 448 episodes of bacteremia due to gram-negative organisms observed during the 7-year period between 1983 and 1989 at Hacettepe University Hospitals were studied for evaluating the factors influencing the prognosis. The overall mortality rate was 45.0%. The mortality rates were not significantly different in "rapidly fatal" and "ultimately fatal" disease groups (48.3% and 45.5%, respectively), whereas it was significantly less (34.8%) in the "nonfatal" disease group compared with the "rapidly fatal" category. There were great differences in the mortality rates among different diseases within the same disease category. Shock, multi-organ failure, source of infection, hospital service, appropriateness of antibiotic therapy, and place of acquisition of infection were found to affect prognosis significantly in multivariate analysis. In conclusion, the identification of prognostic factors is a further step for making necessary interventions in reducing the mortality rate associated with bacteremia due to gram-negative organisms. Underlying disease is still an important prognostic factor; however, a new approach is needed for classification of underlying diseases.

In the constructivist learning theory, the assessment has been carried out as based on the process. The portfolio assessment is one of the assessment techniques based on process. While portfolio is described as a collection comprised of student outcomes, the process covering the analysis of this collection is defined as a portfolio assessment. Portfolio assessment requires the evaluation of individual or group performance of the student, in the learning process rather than evaluating the learning, in a very limited period of time, by checking the answers obtained via multiple choice questions. This study aims at determining the views of teacher candidates on the contributions of portfolio assessment in developing environmental consciousness. Teacher candidates, totally 109, studying in Primary Education Teacher Training Program of Anadolu University Education Faculty and preparing portfolio within the framework of Environment Science course, participated into this research in the spring term of 2004-2005 academic year. The data of the research were collected by a questionnaire. In the analysis of the data, both the quantitative and qualitative data were utilized. In the analysis of quantitative data, the SPSS computer program was used, the frequencies (f) and percentages (%) were calculated and Chi Square (X2) analysis technique was employed. In the analysis of qualitative data, the descriptive analysis technique was used. As a result, it was found that the views of teacher candidates werepositive on the contribution of portfolio evaluation in developing environmental consciousness.

Objectives: The aim of this study was to assess the carbapenem susceptibility of four nosocomial pathogens and to evaluate the reliability of the susceptibility results determined by E-test and disc diffusion (DD) methods. Methods: Escherichia coli (n = 73), Klebsiella pneumoniae (n = 60), Pseudomonas aeruginosa (n = 70) and Acinetobacter spp. (n = 70) isolated from nosocomial infections in 2002–2003 were included in the study. Thirty-five per cent of the strains were isolated from intensive care units. After determining antimicrobial susceptibility against imipenem and meropenem by DD (10 μg; Oxoid, UK) and Etest (AB Biodisk, Solna, Sweden) methods, the results were categorised as susceptible (S), intermediate (I) and resistant (R) according to the NCCLS criteria. For statistical analyses, the intermediate group was included in the resistant category because of the low numbers of bacteria in the former group. Results: None of E. coli or K. pneumoniae strains were resistant to carbapenems, whereas, resistance reached up to 59.0% in Acinetobacter spp. and P. aeruginosa isolates. By either method, the pattern of the susceptibility of the four bacteria was not statistically significantly different for imipenem vs. meropenem. Total agreement of DD and E-test methods for susceptibility to imipenem was 95.7%, and 90.0% in Acinetobacter spp. and P. aeruginosa, respectively; and susceptibility to meropenem was 90.0% for both bacteria. However, the difference of the results obtained by either method was statistically significant for Acinetobacter spp. Conclusion: Study results suggest a high resistance rate for Acinetobacter spp. and P. aeruginosa strains against carbapenem antibiotics in our hospital. Further studies are needed to clarify whether E-test should be used to confirm meropenem resistance of Acinetobacter spp. determined by DD method.

Background —The technical aspects of ductal stenting have been reported, but little is known of the fate of the duct after stent implantation. Methods and Results —Nineteen patients underwent stent implantation to maintain ductal patency. Eight had hypoplastic left heart (HLH) syndrome, 10 had pulmonary atresia, and 1 had tricuspid atresia. Median survival with HLH was 57 (12 to 907) days. Stent implantation was successful in all cases of HLH, but there were no long-term survivors. Two well-palliated infants died at transplantation. Median survival with duct-dependant pulmonary flow was 183 (0 to 1687) days, with 3 patients well at latest follow-up (56, 55, and 9 months, respectively). There were 2 operative deaths due to ductal spasm and 4 late deaths, 1 due to duct thrombosis, 1 due to chronic lung disease, and 2 of unknown cause. Stent implantation failed in 4 of the 11 cases. Assessment of endothelialization was possible in 13 cases; the stent was partially covered in 3 and fully endothelialized in all 10 cases assessed >8 weeks after implantation. In patients stented for inadequate pulmonary flow, ductal intimal hyperplasia occurred by 9 months in all 3 survivors but responded to repeated dilation. Conclusions —Ductal stenting cannot be recommended. In patients with HLH, it provides only short-term palliation even when combined with pulmonary artery banding. With duct-dependent pulmonary blood flow, the procedure carries high risk, and duration of palliation is poor. In patients with bilateral ducts and absent central pulmonary arteries, good palliation may be achieved, but repeated angioplasty is necessary to counteract intimal hyperplasia.

ADIBELLI, ZELAL/0000-0001-7091-5204 WOS: 000252037900111 PubMed: 18089408 Sirolimus-associated pulmonary problems are rare but life threatening. Pulmonary problems due to sirolimus treatment are interstitial pneumonitis, bronchiolitis obliterans organizing pneumonia (BOOP), and alveolar hemorrhage. We present a case of sirolimus-related cough in the absence of any pulmonary radiological findings. A 55-year-old man with a history of 4 years of hemodialysis therapy because of end-stage renal disease of unknown etiology underwent cadaveric renal transplantation in June 2006. Three days following the initiation of sirolimus therapy he complained of dry cough and fever. There were no clinical or laboratory findings compatible with specific pulmonary disease. After switching sirolimus to tacrolimus, the cough improved within 1-2 days and resolved in 5 days. Sirolimus should be considered in the differential diagnosis of pulmonary problems in the early posttransplantation period even in the absence of radiological findings.

Many factors, including severity of illness, neutropenia, intravenous catheter management, and drug therapy may affect the outcome of candidemia in cancer patients.The records of all patients at M. D. Anderson Cancer Center who developed one or more positive blood cultures for Candida spp between January 1, 1988, and December 31, 1992, were retrospectively reviewed. Four hundred ninety-one episodes of candidemia were identified, for which 476 had complete medical records, which were reviewed in detail.By 3-month follow-up, 52% of the patients had died. Neutropenia, higher APACHE III score, and visceral dissemination were associated with poor prognosis. Cure rates, adjusted for severity of illness, were similar for fluconazole and amphotericin B treatment. Exchange of central venous catheters was associated with a modest improvement in prognosis.Several factors that influence the outcome of candidemia in cancer patients have been identified. These factors may be relevant for the clinical management of cancer patients with candidemia, and for the design of therapeutic trials.

Aim This study describes the immediate complications and outcome of children with antenatally-diagnosed cardiac rhabdomyomas, arising as a consequence of the tuberous sclerosis complex (TSC). This group is compared with those diagnosed after birth. Method The paediatric cardiology database was interrogated to identify children with cardiac rhabdomyomas: twenty-one cases were analysed, with nine diagnosed antenatally and twelve after birth. Results Cardiac complications were identified in ¾ of the antenatal group (7 out of 9), compared with a third of the postnatal group (p = 0.08). The commonest antenatal abnormality identified was an outflow tract obstruction, which affected six fetuses. Two significant cases included an intrauterine death at 36 weeks gestation and an induction of labour at 38 weeks, due to a haemodynamically significant left ventricular outflow tract obstruction. Cardiac arrhythmias affected five antenatally-diagnosed fetuses (56%), with one requiring emergency delivery at 28 weeks and ongoing neonatal management. The majority of cardiac rhabdomyomas in both groups were located in the ventricles. Tumour growth continued up to 28 weeks of age amongst all surviving children, followed by spontaneous regression, with no need for resective surgery. There was a high prevalence of neurological morbidity in both groups. Conclusion Antenatal cardiac rhabdomyomas, occurring as part of the TSC, can cause significant morbidity, which is rarely fatal, but warrants careful monitoring until the point of tumour regression. The burden of neurological disease is high in children, compared with the largely favourable cardiac outcome.

Objective To assess the rate of antenatal detection of hypoplastic left heart syndrome (HLHS) and its outcome antenatally and postnatally. This review was undertaken to improve counselling and provide better surgical survival information for expecting parents in the future. Methods All cases of HLHS detected antenatally between January 2002 and December 2008 were included in the study. Fetal medicine and fetal cardiac databases at a tertiary fetal cardiology centre as well as CARIS central database in Wales were utilised to carry out the review. The notes were carefully scrutinised to rule out any confounding variables. Results There were 55 cases of HLHS in South Wales over this period, 50 of which were detected antenatally. 24 of these were terminated following counselling and two ended up in still birth. Hence, there were 24 live births with HLHS. Of these, one died without undergoing any surgery. The remaining 23 cases underwent surgery but five children died. Eighteen of them are alive and are under follow-up. HLHS is an isolated defect in majority of cases (38 out of 50). The rate of chromosomal abnormality is 10% (5 out of 50). Conclusion HLHS is one of the most high-risk lesions in children with congenital heart disease. Antenatal detection rate for HLHS has been satisfactory at 90% in Wales. Termination rate remains high despite substantial improvement in survival after surgery. Post surgical survival stands at 78% in our series with a maximum follow-up of 8 years. Counselling is essential for parents to make an informed decision.

Objective To assess the rate of chromosomal problems with complete atrio-ventricular septal defect. This study was undertaken to improve counselling and provide better information for expecting parents in the future. Methods All cases of complete atrio-ventricular septal defect detected antenatally between January 2002 and December 2008 were included in the study. Fetal medicine and fetal cardiac databases at a tertiary fetal cardiology centre as well as CARIS central database in Wales were utilised to carry out the review. The notes were carefully scrutinised to rule out any confounding variables. Results There were 47 cases of CAVSD in South Wales over this period, 32 of which were detected antenatally. Ten of these were terminated following counselling and three ended up in still birth with one fetal loss. Hence, there were 18 live births with HLHS. Of these, six died postnatally, five of these had chromosomal problems. 23 of the cases diagnosed antenatally had chromosomal problems. 8 of the 10 terminations were complicated with associated chromosomal problems. Two out of the three stillbirths and the fetal loss was also complicated by associated chromosomal anomaly. Out of the 18 live births, 12 had chromosomal problems. Trisomy 21 was the commonest karyotypic abnormality (18 out of 23) in CAVSD with Trisomy 18 comprising the remainder. Conclusion CAVSD is a common congenital heart defect. Antenatal detection rate for CAVSD stands at 68% in Wales. It is associated with a high rate of chromosomal problems (72%). Counselling is essential for parents to make an informed decision.

This research investigates the experiences of women who receive a prenatal diagnosis of congenital heart disease, the patient perception of the referral process to the fetal cardiology service and factors contributing to decision-making during pregnancy. This qualitative research involved semi-structured face-to-face interviews with seven women who had recently received a diagnosis of a fetal heart condition. All interviews were audio recorded and later transcribed to allow thematic analysis to be performed. The most important findings of this research were the high levels of anxiety experienced by participants while waiting to see a fetal cardiac specialist for confirmation of the diagnosis. Receiving the diagnosis of a fetal heart problem resulted in heightened stress levels in all participants although counselling provided by the fetal cardiology team was very effective. Other findings included factors contributing to the decision to undergo invasive prenatal testing and difficulties with communicating the diagnosis to others, although written information and schematic diagrams provided by the fetal cardiologist were considered very helpful in this process. Additionally, pre-planned delivery in a specialist centre was regarded as very reassuring. The results of this study indicated the need for more information to be given by practitioners when an abnormality is first suspected. However the practicalities and appropriateness of the implementation of this require further research. All participants were in agreement that they had benefited from the technology and medical expertise enabling their baby9s diagnosis prenatally and all were satisfied with the care and support provided to them by the fetal cardiology team.

Objective To evaluate the efficacy of flecainide and digoxin combination in acute management of fetal supraventricular tachycardia (SVT) in a tertiary referral centre. Methods Retrospective review of all pregnant women referred with fetal SVT between January 2001 and March 2009. Data were obtained from Fetal Medicine database, Cardiobase and the maternal notes. The notes were carefully scrutinised to rule out any confounding variables. Transabdominal fetal echocardiography was performed to confirm and to determine the type of arrhythmia, cardiac function and to exclude any associated structural abnormality or hydrops. All studies were recorded on a hard drive and videotapes for subsequent playback and analysis. Results 29 cases of fetal SVT presented between 18- and 39-week gestation with a median maternal age of 27 years. 27 were treated with digoxin and flecainide combination. Two were delivered without treatment as both fetuses were at term. Seven fetuses had atrial flutter and remaining 22 had atrioventricular re-entry tachycardia. Hydrops was encountered in six patients, two of whom had atrial flutter and four, atrioventricular re-entry tachycardia. 26 responded to Flecainide and digoxin combination. The time to conversion ranged from less than 24 h to 21 days. Severe hydrops was encountered in one case which was resistant to all intervention. There were no intrauterine deaths due to tachycardia but one pregnancy was terminated due to major non-cardiac abnormalities. Conclusion Combination of Flecainide and Digoxin offers a safe and effective treatment option for fetal SVT with rapid restoration of sinus rhythm.

Aim To determine the reasons, outcome of ante-natally detected congenital heart conditions, incidence with associated co-morbid conditions and the recurrence rate of congenital heart conditions with maternal and fetal conditions in Wales over a period of 7 years 2002–2008. Methodology Retrospective study of 1747 referrals for tertiary fetal cardiology evaluation. Data were obtained from fetal medicine, radiology, neonatal, cardiology databases and case notes. Results The incidence of congenital heart disease in Wales in 13 per 1000 live births. 1747 mothers were referred to Tertiary fetal cardiology assessment. Initial echocardiogram was normal in 1305 (73%) of mothers and discharged from follow up. Abnormal cardiac anatomy and family history of congenital heart disease were the main reasons for referral to fetal cardiology. 62% of fetal demise was contributed by Hypoplastic conditions and AVSDs atrial ventricular septal defect. 64% of terminations were due to four chamber abnormalities. Outflow tract abnormalities remains significant in postnatally detected conditions. 88% of the foetuses with major cardiac anomalies were delivered in paediatric cardiothoracic surgical centres. The incidence of congenital heart disease with maternal insulin dependent diabetes mellitus is 3.7%, with genetic conditions is 30.4% and with associated congenital anomalies is 30%. The recurrence risk for congenital heart disease with family history is 3.7%, with mother herself having congenital heart disease is 8% and with previous pregnancy having major heart conditions is 6.5%. Conclusion The incidence of congenital heart conditions in Wales is high. The pickup rate of outflow tract anomalies was significantly improved after sonographers training programme by the fetal cardiologist.