PERINATAL CARDIAC FUNCTIONAL ADAPTATION IN HYPOPLASTIC LEFT HEART SYNDROME: A LONGITUDINAL ANALYSIS.

BACKGROUND: The perinatal transition is characterized by acute changes in cardiac loading. Compared to normal newborn combined cardiac output (CCO), single right ventricular (RV) output of neonates with hypoplastic left heart syndrome (HLHS) is markedly greater. We sought to examine the mechanisms of cardiac adaptation which facilitate this perinatal transition from late fetal to early neonatal life in HLHS. METHODS: Prospectively recruited pregnancies complicated by fetal HLHS (n=35) and health controls (Ctrl, n=17) underwent serial echocardiography in late gestation (38±1weeks) and 6, 24 and 48 hours after birth. Cardiac function was assessed using conventional, tissue Doppler and speckle tracking echocardiography. RESULTS: Term HLHS fetuses had an RV output (RVCO) comparable to Ctrl CCO via higher stroke volume (SV). Compared to both left ventricular (LV) and RV indices of Ctrls, they exhibited a globular and dilated RV with reduced relative wall thickness (RWT) [RWT: 0.40±0.08 vs. 0.49±0.10, p<0.01], increased Tei index' [HLHS vs. Ctrl LV/Ctrl RV: sphericity index (SI): 0.9±0.25 vs. 0.5±0.10/0.6±0.11, RV area index: 28±6cm2/m2 vs. 15±3cm2/m2/17±5cm2/m2, Tei index': 0.65±0.11 vs. 0.43±0.07/0.45±0.09, all p<0.0001]. HLHS neonates generated elevated RVCO compared to Ctrl CCO via higher heart rate and SV, with further RV dilatation, increased longitudinal systolic strain at 48h [-17±4% vs. -14±3%/-14±5%] with reduced circumferential and rotational myocardial deformation and altered diastolic function. HLHS neonates also demonstrated right atrial (RA) enlargement with increased longitudinal strain: 6h (33±12% vs. 26±6%), 24h (37±15% vs. 26±13%), 48h (38±11% vs. 24±13%), p<0.0001. CONCLUSIONS: Term HLHS fetuses exhibit altered RV geometry and RV systolic and diastolic functional parameters. After birth, further alterations in these cardiac parameters likely reflect adaptation to acutely altered RV loading from increasing cardiac output and pulmonary artery flow demands.

Double-orifice tricuspid valve: case series and literature review.

The double-orifice tricuspid valve (DOTV) is a rare lesion. We present a series of three patients encountered at the Stollery Children's Hospital with a diagnosis of DOTV on 2D and/or 3D echocardiography. The patient's medical records are reviewed for presentation history, investigative findings, and clinical course. We discuss the cases in the context of a complete review of all literature documenting cases of DOTV. In the majority of cases, the lesion is relatively benign, with little change in valve function over the short to medium term, and outcomes are determined largely by significant concomitant heart defects.

Anxiety and Depression after Traumatic Open-Globe Injury.

Introduction: This cross-sectional interview-based study aimed to assess the prevalence and severity of probable anxiety and depression in patients with traumatic open-globe injury and to identify factors associated with anxiety and depression following open-globe injury. Methods: Two hundred and twenty-five patients with open-globe injury were identified at the UC Davis Medical Center between 2008 and 2019. Prisoners and patients under 18 at the time of recruitment were excluded from the study. One hundred and twenty-four patients provided consent to participate in the study, which involved a phone interview and chart review. The interview consisted of a section on sociodemographic data and potential associations followed by the Hospital Anxiety and Depression Scale, a standardized 14-question survey that has been validated in previous studies as an excellent predictor of anxiety and depression. A score of 8 for anxiety or depression was considered a positive test, and patients with a positive test in either category were advised to seek further evaluation with their primary care doctors. The prevalence of probable anxiety and depression was calculated, and linear regression was used to identify factors associated with anxiety and depression. Results: The average age was 50.5 ± 19.2, and 75.8% of patients were male. The anxiety score was positive in 37.9% of patients and the depression score was positive in 28.2%. The mean anxiety and depression scores were 6.3 ± 4.7 and 5.5 ± 4.8, respectively. The P value of the linear regressions for anxiety score and depression score were both < 0.001, with R2 = 0.429 and 0.363, respectively. Younger age (P = 0.002) and unemployment at the time of the interview (P = 0.038) were associated with higher anxiety scores. Patients who were bothered by the appearance of their injured eye had higher anxiety scores (P < 0.001) and depression scores (P < 0.001). Patients without a high school diploma had higher depression scores (P < 0.001). Gender, enucleation status, number of people in support network, use of a prosthetic or scleral shell, final logMAR visual acuity, marital status, months since the initial injury, and presence of an intraocular foreign body were not significantly associated with anxiety or depression scores. Conclusions: Traumatic open-globe injury is associated with a high prevalence of probable anxiety and depression. Dissatisfaction with the appearance of the injured eye was associated with higher anxiety and depression scores. Younger age and unemployment were associated with increased anxiety scores, and lack of a high school diploma was associated with higher depression scores.

Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms.

Introduction: This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries. Methods: A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020. Results: Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases (P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge (P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) (P < 0.001), all of which were evaluated by the facial trauma service (P = 0.002), 77.3% by otolaryngology (P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) (P < 0.001); 83.8% were evaluated by the facial trauma service (P = 0.006), 69.1% by otolaryngology (P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted (P = 0.698); 43.8% survived when not consulted (P = 0.001). Conclusions: Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries.

Disseminated sporotrichosis presenting as left nasolacrimal duct obstruction.

Sporotrichosis, a subacute or chronic mycosis caused by the Sporothrix schenckii complex, is commonly seen in tropical or subtropical parts of the world, especially in individuals who are in contact with cats or engage in gardening activities. Sporotrichosis generally presents with skin ulceration at the site of inoculation and follows a lymphocutaneous pattern; however, it can present in various confounding ways. Here, we present a case of disseminated sporotrichosis in an immunocompromised patient who did not seem to have any of the commonly associated risk factors and initially presented with a left nasolacrimal duct obstruction caused by lacrimal sac sporotrichosis, but then was found to have monoarticular involvement of his knee also secondary to disseminated sporotrichosis. Thorough clinical and microbiological evaluation, as well as multidisciplinary work, can lead to correct diagnosis and treatment of sporotrichosis, especially for atypical presentations in immunocompromised individuals.

Overload in a Rat In Vivo Model of Synergist Ablation Induces Tendon Multiscale Structural and Functional Degeneration.

Tendon degeneration is typically described as an overuse injury with little distinction made between magnitude of load (overload) and number of cycles (overuse). Further, in vivo, animal models of tendon degeneration are mostly overuse models, where tendon damage is caused by a high number of load cycles. As a result, there is a lack of knowledge of how isolated overload leads to degeneration in tendons. A surgical model of synergist ablation (SynAb) overloads the target tendon, plantaris, by ablating its synergist tendon, Achilles. The objective of this study was to evaluate the structural and functional changes that occur following overload of plantaris tendon in a rat SynAb model. Tendon cross-sectional area (CSA) and shape changes were evaluated by longitudinal MR imaging up to 8 weeks postsurgery. Tissue-scale structural changes were evaluated by semiquantified histology and second harmonic generation microscopy. Fibril level changes were evaluated with serial block face scanning electron microscopy (SBF-SEM). Functional changes were evaluated using tension tests at the tissue and microscale using a custom testing system allowing both video and microscopy imaging. At 8 weeks, overloaded plantaris tendons exhibited degenerative changes including increases in CSA, cell density, collagen damage area fraction (DAF), and fibril diameter, and decreases in collagen alignment, modulus, and yield stress. To interpret the differences between overload and overuse in tendon, we introduce a new framework for tendon remodeling and degeneration that differentiates between the inputs of overload and overuse. In summary, isolated overload induces multiscale degenerative structural and functional changes in plantaris tendon.

Cytoplasmic dynein1 intermediate-chain2 regulates cellular trafficking and physiopathological development in Magnaporthe oryzae.

The cytoplasmic dynein 1, a minus end-directed motor protein, is an essential microtubule-based molecular motor that mediates the movement of molecules to intracellular destinations in eukaryotes. However, the role of dynein in the pathogenesis of Magnaporthe oryzae is unknown. Here, we identified cytoplasmic dynein 1 intermediate-chain 2 genes in M. oryzae and functionally characterized it using genetic manipulations, and biochemical approaches. We observed that targeted the deletion of MoDYNC1I2 caused significant vegetative growth defects, abolished conidiation, and rendered the ΔModync1I2 strains non-pathogenic. Microscopic examinations revealed significant defects in microtubule network organization, nuclear positioning, and endocytosis ΔModync1I2 strains. MoDync1I2 is localized exclusively to microtubules during fungal developmental stages but co-localizes with the histone OsHis1 in plant nuclei upon infection. The exogenous expression of a histone gene, MoHis1, restored the homeostatic phenotypes of ΔModync1I2 strains but not pathogenicity. These findings could facilitate the development of dynein-directed remedies for managing the rice blast disease.

Implementation of Virtual Fontan Heart Camps During a Pandemic.

BACKGROUND: Children with a Fontan operation represent a unique form of congenital heart disease (CHD) that requires multiple cardiac surgeries and procedures with an uncertain long-term outcome. Given the rarity of the types of CHD that require this procedure, many children with a Fontan do not know any others like them. METHODS: With the cancelation of medically supervised heart camps due to the COVID-19 pandemic, we have organized several physician-led virtual day camps for children with a Fontan operation to connect with others in their province and across Canada. The aim of this study was to describe the implementation and evaluation of these camps via the use of an anonymous online survey immediately after the event and reminders on days 2 and 4 postevent. RESULTS: Fifty-one children have participated in at least 1 of our camps. Registration data showed that 70% of participants did not know anyone else with a Fontan. Postcamp evaluations showed that 86% to 94% learned something new about their heart and 95% to 100% felt more connected to other children like them. CONCLUSION: We have demonstrated the implementation of a virtual heart camp to expand the support network for children with a Fontan. These experiences may help to promote healthy psychosocial adjustments through inclusion and relatedness.

Lateral orbital wall anomaly in a patient with thyroid eye disease.

An isolated defect in the lateral orbital wall is an uncommon occurrence, although cases of orbital floor, roof, and medial wall spontaneous dehiscence have been described in the literature. Here, we describe a lateral orbital wall defect in a patient with thyroid eye disease - which may be related to bony remodeling or may represent a rare congenital anomaly. Computed tomography (CT) prior to decompression surgery revealed a defect in the left lateral orbital wall. At the time of orbital decompression, prolapse of buccal fat into the orbit was noted once the subperiosteal plane was entered along the lateral orbital wall in the area of this bony defect. Literature review revealed only a few previous reports of lateral wall abnormalities, including two involving the inferior orbital fissure; one other case was associated with Down syndrome, and other reports consist of sphenoid hypoplasia associated with neurofibromatosis.

Review of sociodemographic risk factors for presentation with advanced non-melanoma skin cancer.

PURPOSE: Non-melanoma skin cancers (NMSC) are often localized and associated with an excellent prognosis but a minority present with locally advanced or metastatic disease requiring extensive resection or systemic treatment. Medical factors that increase the risk of advanced skin cancers such as tobacco use, systemic immunosuppression or genetic syndromes have been described but the sociodemographic risk factors are relatively uninvestigated and under reported. In this review a cohort of patients presenting with periorbital NMSC is reviewed for social determinants of health correlated with presentation with advanced disease. METHODS: Patients presenting with periorbital NMSC during a 10-year period are categorized as advanced (those tumors requiring extensive local resection, sacrifice of the globe or systemic therapy) or non-advanced and demographic features are compared between the two groups. RESULTS: 274 cases of periorbital NMSC were classified as either non-advanced (177) or advanced (97). Patients with public safety net health insurance were twice as likely to present with advanced disease (25% vs 13%). Patients with advanced disease were significantly less likely to be under the care of a primary care physician, lived in economically depressed areas with lower mean household incomes, and lived further from tertiary medical care. CONCLUSION: Financial and sociodemographic features are strongly associated with presentation with advanced NMSC. Further work is needed to determine which sociodemographic features are independent risk factors. A better understanding of the relevant barriers to care may reduce the burden of advanced disease at presentation in the future.

The effectiveness and safety of acupuncture treatment on sciatica: A systematic review and meta-analysis.

BACKGROUND: Sciatica results from primary or secondary damage to the sciatic nerve in the lumbar or gluteal region. The first option for sciatica is analgesics, but their therapeutic effect and safety in long-term use are questionable. On the other hand, acupuncture has recently been recognized as a complementary and alternative medicine (CAM) to conventional medicine, and studies on its effectiveness and safety have been actively conducted. OBJECTIVE: To systematically compare acupuncture with analgesics in terms of effect, safety, and durability in the treatment of sciatica METHODS: This review was performed in accordance with Cochrane Handbook for Systematic Reviews of Interventions Version 6.2. Four databases were searched for this review: Wangfang, the Korean Traditional Knowledge Portal (KTKP), PubMed, and EBSCOhost. The primary outcome measures in the review were total effective rate (TER), visual analog scale (VAS) score and pain threshold, and the secondary ones were adverse effects (AEs) and relapse rates. Risk ratio (RR) for TER and mean difference (MD) for VAS score and pain threshold were used as statistics for the meta-analysis of effectiveness, along with associated 95 % confidence intervals (CIs) and P-values. AEs and relapse rates were used for the safety and durability of the interventions. Version 2 of the Cochrane risk-of-bias assessment tool for randomized trials (RoB 2) was used for the methodological quality of randomized controlled trials (RCTs) included in the review. RESULTS: The synthesized TER of 28 RCTs involving 2707 participants was significantly higher in the acupuncture group compared to the analgesic group (RR [95 % CI] = 1.20 [1.16, 1.24], P < 0.001). The synthesized VAS score of 7 RCTs involving 589 participants was significantly reduced in the acupuncture group compared to the analgesic group (MD [95 % CI] = - 1.78 [- 2.44, - 1.12], P < 0.001). In 5 RCTs involving 311 participants, the synthesized pain threshold was significantly elevated in the acupuncture group compared to the analgesic group (MD [95 % CI] = 0.93 [0.64, 1.22], P < 0.001). Additionally, adverse effects (AEs) and relapse rates of RCTs in the review were lower in the acupuncture group compared to the analgesic group. CONCLUSION: In this systematic review, acupuncture treatment was significantly effective and safe compared to analgesics in sciatica. In the future, studies with a rigorous study design are required to increase the validity of the effectiveness and safety of acupuncture treatment for sciatica.

Clinical image: Rare photographic documentation of uveal melanoma progression.

To present clinical images of a patient with neovascular glaucoma and hypermature cataract masking orbital extension of a uveal melanoma. Observations: A 67-year-old female was referred for neovascular glaucoma and found to have an intraocular tumor with massive orbital extension. She refused surgery and returned one year later with progression of the tumor with metastases and expired seven months later. Conclusions and importance: Unexplained glaucoma and cataract should be investigated for harboring underlying intraocular tumors to prevent delays in diagnosis. Providers also should obtain greater understanding of psychosocial and socioeconomic barriers to healthcare.

Extra-cardiac diagnoses and postnatal outcomes of fetal tetralogy of fallot.

OBJECTIVE: Past studies of fetal tetralogy of fallot (ToF) have reported extra-cardiac anomalies (ECAs) in 17%-45%, genetic syndromes in as low as 20% and poor postnatal outcomes. This study sought to examine these factors in a contemporary cohort. METHODS: A retrospective review examining 83 fetuses with ToF diagnosed 2012-2019. Referral indication, ToF subtype, additional cardiac, extra-cardiac and genetic diagnoses, pregnancy outcomes and survival were documented. RESULTS: The mean gestational age at diagnosis was 23 ± 4 weeks. Of 94% (78/83) with genetic testing (GT), 30% (23/78, 95%CI 21%-40%) had genetic anomalies (GA), including Trisomy 21 (39%, 9/23), 22q11 deletion (35%, 8/23), Trisomy 13 or 18 (17%, 4/23) and 9% (2/23) others. A further 4% (3/78) had VACTERL association. Forty-one percent (34/83, 95%CI 31%-52%) had ≥1 major ECA of whom 41% (14/34) also had a genetic anomaly. OUTCOMES: 22% (18/83) pregnancy termination, 5% (4/83) intrauterine death and 72% (60/83) live birth. Of live births, 3% (2/60) experienced neonatal death, 7% late death (4/60) and 90% (54/60) were alive at last follow-up (mean age 3.5 ± 2.4 years). CONCLUSION: In a cohort of fetuses with ToF and high rates of GT, compared to previous reports, GA were more common and there were similar rates of ECAs.

Traumatic Optic Neuropathy Management: A Survey Assessment of Current Practice Patterns.

INTRODUCTION: The treatment of traumatic optic neuropathy (TON) is highly controversial with a lack of substantiated evidence to support the use of corticosteroids or surgical decompression of the optic nerve. The aim of the study was to determine if there was a general consensus in the management of TON despite controversy in the literature. METHODS: An anonymous survey of members of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the North American Neuro-Ophthalmology Society regarding their practice patterns in the management of patients with TON was performed. RESULTS: The majority of 165 respondents indicated that they treated TON with corticosteroids (60%) while a significant minority (23%) performed surgical interventions (P < 0.0001). Subgroup analysis comparing rates of treatment with steroids among oculoplastic surgeons and neuro-ophthalmologists (67% vs. 47%) was not significant (Fisher's Exact test [FET], P =0.11) while results did suggest that a higher proportion of oculoplastic surgeons (33%) than neuro-ophthalmologists (11%) recommended surgical intervention (FET, P =0.004). In cases where visual acuity exhibited a downward trend treatment with steroids was the most commonly employed management. In general, neuro-ophthalmologists trended toward observation over treatment in TON patients with stable visual acuity while oculoplastic surgeons favored treatment with corticosteroids. CONCLUSIONS: In spite of the lack of class I evidence supporting intervention of TON, the majority of respondents were inclined to offer corticosteroid treatment to patients whose visual acuity showed progressive decline following injury.

Tricuspid Valve Tethering Is Associated with Residual Regurgitation after Valve Repair in Hypoplastic Left Heart Syndrome: A Three-Dimensional Echocardiographic Study.

BACKGROUND: Tricuspid valve regurgitation (TR) is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). Surgical tricuspid valve (TV) repair is common, but durable repair remains challenging. The aim of this study was to examine mechanisms of TR requiring surgery, features associated with unsuccessful repair, and TV changes after surgical repair. METHODS: Thirty-six patients with HLHS requiring TV repair (TVR) and 36 matched control subjects with HLHS were assessed using two-dimensional and three-dimensional echocardiography. Using three-dimensional echocardiography, TV coordinates from the annulus, leaflet, and ventricle were used to measure annular, leaflet, prolapse, and tethering values and anterior papillary muscle angle. TR grade and ventricular size, function, and shape were assessed using two-dimensional echocardiography. RESULTS: Patients requiring TVR had greater total leaflet prolapse, larger TV annular and leaflet areas, and flatter annuli, with no difference in tethering, coaptation index, or anterior papillary muscle angle. In patients with HLHS, successful TVR at follow-up (58%) was associated with preoperative total leaflet prolapse (especially posterior). Unsuccessful repair was associated with preoperative tethering of the septal leaflet. TVR in patients with HLHS caused a reduction of total annular and leaflet size and reduced prolapse and tethering of the posterior leaflet but did not affect anterior leaflet prolapse or septal leaflet tethering. CONCLUSIONS: Features associated with TVR include a flattened and dilated TV annulus with leaflet prolapse. The additional presence of a tethered septal leaflet before TVR is associated with significant postoperative TR. Current surgical techniques, predominantly posterior annuloplasty and commissuroplasty, adequately address annular size and posterior leaflet pathology, but not septal leaflet tethering. Individualized and innovative surgical techniques are vital to improve surgical repair success.

Persistent Aortic Stiffness and Left Ventricular Hypertrophy in Children of Diabetic Mothers.

BACKGROUND: Fetuses of diabetic mothers develop left ventricular (LV) hypertrophy and are at increased long-term risk of cardiovascular disease. In our previous longitudinal study from midgestation to late infancy we showed persistence of LV hypertrophy and increased aortic stiffness compared with infants of healthy mothers, the latter of which correlated with third trimester maternal hemoglobin A1c. In the present study, we reexamined the same cohort in early childhood to determine if these cardiovascular abnormalities persisted. METHODS: Height, weight, and right arm blood pressure were recorded. A full functional and structural echocardiogram was performed with offline analysis of LV posterior wall and interventricular septal diastolic thickness (IVSd), systolic and diastolic function, and aortic pulse wave velocity. Vascular reactivity was assessed using digital thermal monitoring. Participants also completed a physical activity questionnaire. RESULTS: Twenty-five children of diabetic mothers (CDMs) and 20 children from healthy pregnancies (mean age, 5.6 ± 1.7 and 5.3 ± 1.3 years, respectively; P = not significant) were assessed. Compared with controls, IVSd z score was increased in CDMs (1.2 ± 0.6 vs 0.5 ± 0.3, respectively; P = 0.006), with one-fifth having a z score of more than +2.0. Aortic pulse wave velocity was increased in CDMs (3.2 ± 0.6 m/s vs 2.2 ± 0.4 m/s; P = 0.001), and correlated with IVSd z score (R 2 = 0.81; P = 0.001) and third trimester maternal A1c (R 2 = 0.65; P < 0.0001). Body surface area, height, weight, blood pressure, vascular reactivity, and physical activity scores did not differ between groups. Our longitudinal analysis showed that individuals with greater IVSd, and aortic stiffness in utero, early and late infancy also tended to have greater measures in early childhood (P < 0.001 and P < 0.0001, respectively). CONCLUSIONS: CDMs show persistently increased interventricular septal thickness and aortic stiffness in early childhood.

INTRODUCTION: Les fœtus des mères diabétiques présentent une hypertrophie du ventricule gauche (VG) et sont exposés à un risque accru à long terme de souffrir d'une maladie cardiovasculaire. Dans notre étude longitudinale précédente qui portait sur la période mi-gestationnelle à la fin de la première enfance, nous avons montré la persistance de l'hypertrophie du VG et l'augmentation de la rigidité aortique par rapport aux bébés des mères bien portantes, qui sont en corrélation avec le troisième trimestre de l'hémoglobine A1c maternelle. Dans la présente étude, nous avons réexaminé la même cohorte au début de la seconde enfance pour déterminer si ces anomalies cardiovasculaires persistaient. MÉTHODES: Nous avons enregistré la taille, le poids et la pression artérielle au bras droit. Nous avons réalisé une échocardiographie complète pour évaluer l'état fonctionnel et structurel par analyse hors ligne de la paroi postérieure du VG et de l'épaisseur du septum interventriculaire en diastole (SIVd), la fonction systolique et diastolique, et la vitesse de l'onde de pouls aortique. Nous avons évalué la réactivité vasculaire à l'aide de la surveillance thermique numérique. Les participants ont également rempli un questionnaire sur l'activité physique. RÉSULTATS: Vingt-cinq enfants issus de mères diabétiques (EMD) et 20 enfants de mères bien portantes (âge moyen, 5,6 ± 1,7 et 5,3 ± 1,3 ans, respectivement ; P = non significatif) ont fait l'objet d'une évaluation. Comparativement aux témoins, les EMD avaient un score z du SIVd plus élevé (1,2 ± 0,6 vs 0,5 ± 0,3, respectivement ; P = 0,006), et un cinquième de ces enfants avaient un score z de plus de +2,0. La vitesse de l'onde de pouls aortique était plus élevée chez les EMD (3,2 ± 0,6 m/s vs 2,2 ± 0,4 m/s ; P = 0,001), et était en corrélation avec le score z du SIVd (R 2 = 0,81 ; P = 0,001) et le troisième trimestre de l'A1c maternelle (R 2 = 0,65 ; P < 0,0001). Les scores de la surface corporelle, la taille, le poids, la pression artérielle, la réactivité vasculaire et l'activité physique ne différaient pas entre les groupes. Notre étude longitudinale a montré que les individus qui avaient une plus grande SIVd et une rigidité aortique in utero, au début et à la fin de la première enfance, avaient également tendance à avoir des mesures plus grandes au début de la seconde enfance (P < 0,001 et P < 0,0001, respectivement). CONCLUSIONS: Les EMD montrent une persistance de l'augmentation de l'épaisseur du septum interventriculaire et de l'augmentation de la rigidité aortique au début de la seconde enfance.

Clinical correlation recommended: accuracy of clinician versus radiologic interpretation of the imaging of orbital lesions.

Purpose: To assess the accuracy of radiographic interpretation between the clinician and radiologist when compared to histopathology of orbital lesions. Methods: A retrospective chart review of patients at the University of California Davis Eye Center who underwent orbitotomy from 1/1/2000 to 5/22/2019 was performed. Charts with a preoperative imaging report, preoperative clinical assessment including the clinician's interpretation of imaging, and histopathologic diagnosis were included. The specific diagnoses were grouped into related classes of pathology for the analysis. The clinical and radiologic assessments were compared against the final histopathologic diagnosis for concordance. A concordance analysis was performed. Results: 242 patients (mean age 49 years, 53.5% female) were reviewed. Of these records 185 documented the clinician's clinical impression, the radiology report, as well as the histopathology report. The clinician's preoperative assessment had substantial agreement [kappa = 0.72 (0.65,0.79)] with the final histopathologic result and was correct in 75.7% (140/185) of cases whereas the radiology report was correct in 52.4% (97/185) with a moderate level of agreement [kappa = 0.47 (0.39, 0.55)]. In 49.2% (91/185) of cases the final histopathology correlated with both the clinical impression and radiology report [kappa = 0.58 (0.55, 0.61)]. Conclusions: The accurate interpretation of orbital imaging is a challenge and histopathologic examination remains the gold standard for diagnosis. While orbital imaging is a valuable diagnostic tool the interpretation of these studies is most accurate when conducted in the context of the patient's medical history, clinical exam, and with the physician most familiar with various orbital lesions.

Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Comparison of Norwood vs. Hybrid.

Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. However, it is unclear if the most marked observed remodeling post-Norwood is secondary to cardiopulmonary bypass (CPB) exposure or if it is an adaptation intrinsic to the systemic RV. This study aims to determine the impact of CPB on RV remodeling in HLHS. Echocardiograms of HLHS survivors undergoing stage 1 Norwood (n = 26) or Hybrid (n = 20) were analyzed at pre- and post-stage 1, pre- and post-bidirectional cavo-pulmonary anastomosis (BCPA), and pre-Fontan. RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (global radial shortening (GRS) = peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential) were assessed. Both groups had similar age, clinical status and functional parameters pre-stage 1. No difference in RV size and sphericity at any stage between groups. RVFAC was normal (> 35%) throughout for both groups. Both Norwood and Hybrid patients had increased GRS (p = 0.0001) post-stage 1 and corresponding unchanged longitudinal strain, resulting in decreased deformation ratio (greater relative RV circumferential contraction), p = 0.0001. Deformation ratio remained decreased in both groups in subsequent stages. Irrespective of timing of the first CPB exposure, both Norwood and Hybrid patients underwent similar RV remodeling, with relative increase in circumferential to longitudinal contraction soon after stage 1 palliation. The observed RV remodeling in HLHS survivors were minimally impacted by CPB.

A Novel Right Ventricular Volume and Pressure Loaded Piglet Heart Model for the Study of Tricuspid Valve Function.

Heart conditions in which the tricuspid valve (TV) faces either increased volume or pressure stressors are associated with premature valve failure. Mechanistic studies to improve our understanding of the underlying pathophysiology responsible for the development of premature TV failure are lacking. Due to the inability to conduct these studies in humans, an animal model is required. In this manuscript, we describe the protocols for a novel chronic recovery infant piglet heart model for the study of changes in the TV when placed under combined volume and pressure stress. In this model, volume loading of the right ventricle and the TV is achieved through the disruption of the pulmonary valve. Then pressure loading is accomplished through the placement of a pulmonary artery band. The success of this model is assessed at four weeks post intervention surgery through echocardiography, intracardiac pressure measurement, and pathologic examination of the heart specimens.

Misdiagnosis of Bell's palsy: Case series and literature review.

Although Bell's palsy is a common etiology for isolated facial paralysis, it is important clinicians perform a complete neurologic examination to avoid misdiagnosis. Multiple cranial neuropathy is often caused by tumor or infection.