Outcome of patients with tetralogy of Fallot repair over 50 years of age

Purpose

To report the outcomes of patients with repaired tetralogy of Fallot (TOF) above 50 years of age.

Methods

We reviewed records of TOF patients who were followed in our institution since 2000. Demographic data, surgical reports and long-term outcomes were analyzed retrospectively.

Results

Thirty-five of 297 (12%) patients who underwent TOF repair were above 50 years of age (25 men [60%]) at the last follow-up. Eighteen patients (48%) had prior palliative surgery. The mean age at the first repair was 18±13 years (5 patients after 40 years of age). Reoperation with pulmonary valve replacement was performed in 10 (28%) patients, and a second redo surgery in 6 (17%) patients. During a mean 17± 2 years follow-up 7 (8.5%) patients died (n=6 end-stage heart failure, n=1 infective endocarditis). At the last follow-up 21/35 patients (60%) were treated with tachyarrhythmia, 19/35 (54%) with chronic heart failure and 17/35 (48%) with comorbidities (hypertension, coronary artery disease/peripherial artery disease, diabetes mellitus, renal failure). Using multivariate analysis the only predictor of death was heart failure (OR: 6.8). Furthermore atrial tachycardia (OR: 8.8) and at least grade II tricuspid regurgitation (OR: 5.0) were identified as predictors of heart failure.

Conclusion

This historical cohort of TOF patients with late repair has a high morbidity rate later in life. Approximately half of the patients require treatment for chronic heart failure, arrhythmias and cardiovascular related comorbidities. Atrial tachycardia and tricuspid regurgitation are strong predictors for heart failure. In this population the strongest predictor for death is heart failure.

Funding Acknowledgement

Type of funding source: None

A transition-edge sensor-based x-ray spectrometer for the study of highly charged ions at the National Institute of Standards and Technology electron beam ion trap

We report on the design, commissioning, and initial measurements of a Transition-Edge Sensor (TES) x-ray spectrometer for the Electron Beam Ion Trap (EBIT) at the National Institute of Standards and Technology (NIST). Over the past few decades, the NIST EBIT has produced numerous studies of highly charged ions in diverse fields such as atomic physics, plasma spectroscopy, and laboratory astrophysics. The newly commissioned NIST EBIT TES Spectrometer (NETS) improves the measurement capabilities of the EBIT through a combination of high x-ray collection efficiency and resolving power. NETS utilizes 192 individual TES x-ray microcalorimeters (166/192 yield) to improve upon the collection area by a factor of ∼30 over the 4-pixel neutron transmutation doped germanium-based microcalorimeter spectrometer previously used at the NIST EBIT. The NETS microcalorimeters are optimized for the x-ray energies from roughly 500 eV to 8000 eV and achieve an energy resolution of 3.7 eV-5.0 eV over this range, a more modest (<2×) improvement over the previous microcalorimeters. Beyond this energy range, NETS can operate with various trade-offs, the most significant of which are reduced efficiency at lower energies and being limited to a subset of the pixels at higher energies. As an initial demonstration of the capabilities of NETS, we measured transitions in He-like and H-like O, Ne, and Ar as well as Ni-like W. We detail the energy calibration and data analysis techniques used to transform detector counts into x-ray spectra, a process that will be the basis for analyzing future data.

Measuring the difference in nuclear charge radius of Xe isotopes by EUV spectroscopy of highly charged Na-like ions

The difference in the mean-square nuclear charge radius of xenon isotopes was measured utilizing a method based on extreme ultraviolet spectroscopy of highly charged Na-like ions. The isotope shift of the Na-like D1 (3s 2 S 1/2 - 3p 2 P 1/2) transition between the 124Xe and 136Xe isotopes was experimentally determined using the electron-beam ion-trap facility at the National Institute of Standards and Technology. The mass-shift and the field-shift coefficients were calculated with enhanced precision by the relativistic many-body perturbation theory and multiconfiguration Dirac-Hartree-Fock method. The mean-square nuclear charge radius difference was found to be δ〈r 2〉136,124 = 0.269(42) fm2. Our result has smaller uncertainty than previous experimental results and agrees with the literature values.

Rheological Evaluation and Observations of Extrusion Instabilities of Biodegradable Polyesters

The rheological properties of two commercially available biodegradable polyesters – poly(lactic acid) (PLA) and aliphatic-aromatic co-polyester Ecoflex™ – have been investigated. The rheological study was focused on measuring the viscosity and examining sharkskin, melt fracture, and extrudate swell phenomena, which are crucial in industrial applications. The experiments show that the two biodegradable polyesters exhibit shear-thinning behavior similar to other polymers and the Cox-Merz rule is obeyed. It was observed that with increasing shear rate PLA exhibits sharkskin and gross melt fracture while Ecoflex™ exhibits only gross melt fracture. Experimental results indicate that both biodegradable polyesters exhibit small extrudate swell, up to 28% for PLA and up to 34% for Ecoflex™.

Testing three-body quantum electrodynamics with trapped Ti20+ ions: evidence for a Z-dependent divergence between experiment and calculation

We report a new test of quantum electrodynamics (QED) for the w (1s2p(1)P(1)→1s(2)(1)S(0)) x-ray resonance line transition energy in heliumlike titanium. This measurement is one of few sensitive to two-electron QED contributions. Systematic errors such as Doppler shifts are minimized in our experiment by trapping and stripping Ti atoms in an electron beam ion trap and by applying absolute wavelength standards to calibrate the dispersion function of a curved-crystal spectrometer. We also report a more general systematic discrepancy between QED theory and experiment for the w transition energy in heliumlike ions for Z>20. When all of the data available in the literature for Z=16-92 are taken into account, the divergence is seen to grow as approximately Z(3) with a statistical significance on the coefficient that rises to the level of 5 standard deviations. Our result for titanium alone, 4749.85(7) eV for the w line, deviates from the most recent ab initio prediction by 3 times our experimental uncertainty and by more than 10 times the currently estimated uncertainty in the theoretical prediction.

Rotational Foam Molding of Metallocene Catalyzed Polyethylene: CBA Screening and Process Characteristics

The objective of this work is to investigate the effects of different chemical blowing agents (CBAs) and processing conditions on the cellular structure of foamed metallocene polyethylene and characterize an appropriate blowing agent. An experimental study was conducted to produce metallocene polyethylene foams in dry-blending-based rotational foam molding. The critical processing parameters that optimize the foam structure have been identified through modifications of the molding conditions. The physical properties and cellular structure of the final foamed parts were also examined. The foaming performance of exothermic and endothermic CBAs was studied. It was revealed that selecting a suitable CBA is crucial as the foam structure depends significantly on the properties of the blowing agent. Exothermic blowing agents resulted in greater foam density reduction and exhibited a wider processing window compared to endothermic blowing agents. It was found that a balance between different properties of the blowing agent is required to achieve control over the foam structure.

Study of solvent-protein coupling effects by neutron scattering

The present work aims to characterize the dynamical behavior of proteins immersed in bio-preserving liquids and glasses. For this purpose, the protein dUTPase was chosen, while the selected solvents were glycerol, a triol, and some homologous disaccharides, i.e., trehalose, maltose, and sucrose, which are known to be very effective bio-preserving agents. The results highlight that the disaccharides show a slowing down effect on the water dynamics, which is stronger for trehalose than in the case of the other disaccharides. Furthermore, a characterization of the medium which hosts the protein is performed by using an operative definition of fragility based on the mean square displacement extracted by elastic incoherent neutron scattering, which is directly connected to Angell's kinetic fragility based on the viscosity. Finally, a study of the dynamics of the protein sequestered within the solvents is performed. The result shows that the protein dynamics is coupled with that of the surrounding matrix.

The implementation of quality management systems in hospitals: a comparison between three countries

Background

Is the implementation of Quality Management (QM) in health care proceeding satisfactorily and can national health care policies influence the implementation process? Policymakers and researchers in a country need to know the answer to this question. Cross country comparisons can reveal whether sufficient progress is being made and how this can be stimulated.

The objective of the study was to investigate agreement and disparities in the implementation of QMS between The Netherlands, Hungary and Finland with respect to the evaluation model used and the national policy strategy of the three countries.

Methods

The study has a cross sectional design, based on measurements in 2000. Empirical data about QM-activities in hospitals were gathered by a self-administered questionnaire. The questionnaires were answered by the directors of the hospitals or the quality coordinators. The analyses are based on data from 101 hospitals in the Netherlands, 116 hospitals in Hungary and 59 hospitals in Finland.

Outcome measures are the developmental stage of the Quality Management System (QMS), the development within five focal areas, and distinct QM-activities which were listed in the questionnaire.

Results

A mean of 22 QM-activities per hospital was found in the Netherlands and Finland versus 20 QM-activities in Hungarian hospitals. Only a small number of hospitals has already implemented a QMS (4% in The Netherlands,0% in Hungary and 3% in Finland). More hospitals in the Netherlands are concentrating on quality documents, whereas Finnish hospitals are concentrating on training in QM and guidelines. Cyclic quality improvement activities have been developed in the three countries, but in most hospitals the results were not used for improvements. All three countries pay hardly any attention to patient participation.

Conclusion

The study demonstrates that the implementation of QM-activities can be measured at national level and that differences between countries can be assessed. The hypothesis that governmental legislation or financial reimbursement can stimulate the implementation of QM-activities, more than voluntary recommendations, could not be confirmed. However, the results show that specific obligations can stimulate the implementation of QM-activities more than general, framework legislation.

Lymphatics in the aorta of rats treated with a soy-bean oil extract (lipofundin)

Lipofundin-S 20% (a soy-bean oil extract) when administered intravenously to rats resulted in dilation of aortic lymphatics at the media-adventitia junction. Increased endothelial permeability as demonstrated by intraaortic colloidal iron uptake with dynamic insufficiency of lymphatic drainage is suggested as the basis for dilatation of intraaortic adventitial lymphatics.

Lysergic Acid Diethylamide (LSD): No Teratogenicity in Rats

Lysergic acid diethylamide (LSD) in doses of 1.5 to 300 micrograms was given to 55 pregnant rats during periods of organogenesis and on the 4th or 5th day of pregnancy to 34 rats. Examination of the resultant 887 young for congenital defects showed no greater frequency than in controls. These experimtents failed to prove that LSD is teratogenic in rats.

Chromosome changes in embryos treated with various teratogens

The association of chromosome changes with certain syndromes of congenital malformations has raised new questions as to the possible role of abnormal chromosome complements in teratogenesis. For example, mosaics are thought to originate in the first divisions of the fertilized ovum, and one may ask how late in embryogenesis permanent chromosome changes can be induced. Investigations have been undertaken in this laboratory to ascertain whether teratogens administered to pregnant rats on the 11–13th days of gestation, when many malformations can be induced, will result in embryos with chromosomal aberrations as well as malformations.

In a previous report (Soukup, Takacs & Warkany, 1965) we have described experiments in which pregnant rats were treated with teratogenic doses of X-ray followed by examination of embryos for detectable chromosome abnormalities.

In embryos irradiated on the 13th day with 400 r and examined 6–12 h later, approximately 60 % of the countable metaphase figures revealed chromosome aberrations.