Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries

AIMS: To examine the prevalence of sustained ventricular tachycardia (VT) and sudden death (SD) in adults with atrial repair of transposition of the great arteries (TGA) and to determine associated risk factors. METHODS AND RESULTS: In a single-centre review, we studied the outcome of 149 adults (mean age 28 +/- 7 years) who had undergone a Mustard operation for TGA. During a mean follow-up of 9 +/- 6 years, sustained VT and/or SD occurred in 9% (13/149) of the cohort. Sustained VT/SD was more likely to occur in patients with associated anatomic lesions [hazard ratio (HR) 4.9, 95% CI 1.5-16.0], with NYHA class >or=III (HR 9.8, 95% CI 3.0-31.6) and with an impaired subaortic right ventricular (RV) ejection fraction (EF) (HR 2.2, 95% CI 1.2-4.0 per 10% decrease in EF). There was an inverse correlation between the RV-EF and both age and QRS duration. Patients with a QRS duration >or=140 ms were at highest risk of sustained VT/SD (HR 13.6, 95% CI 2.9-63.4). Atrial tachyarrhythmia was detected in 66 (44%) patients, but was not a statistically significant predictor of sustained VT/SD in our adult population (HR 2.7, 95% CI 0.6-13.0). CONCLUSION: Sustained VT/SD in adults after a Mustard operation for TGA are more common than previously described. Age, systemic ventricular function, and QRS duration are interrelated and are associated with VT/SD. A QRS duration >or=140 ms helps to identify the high risk patient.

Congenitally corrected transposition of the great arteries in an 80 year old woman

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. An 80 year old woman was admitted to the hospital because of mild congestive heart failure. Cardiac examination revealed a 4/6 holosystolic and a 2/6 decrescendo diastolic murmur at the left sternal border. Radiography, echocardiography, and computed tomography confirmed newly diagnosed CCTGA without associated intracardiac defects.

Search for a light charged Higgs boson in the decay channel H⁺ o c ars in t art events using collisions at sqrts = 7 TeV with the ATLAS detector

A search for a charged Higgs boson (H+) in t (t) over bar decays is presented, where one of the top quarks decays via t -> H(+)b, followed by H+ -> two jets (c (s) over bar). The other top quark decays to Wb, where the W boson then decays into a lepton (e/mu) and a neutrino. The data were recorded in pp collisions at root s = 7 TeV by the ATLAS detector at the LHC in 2011, and correspond to an integrated luminosity of 4.7 fb(-1). With no observation of a signal, 95 % confidence level (CL) upper limits are set on the decay branching ratio of top quarks to charged Higgs bosons varying between 5 % and 1 % for H+ masses between 90 GeV and 150 GeV, assuming B(H+ -> c (s) over bar) = 100 %.

The Rabbinate of the Great Synagogue, London : from 1756 - 1842

by C. Duschinsky

Rabbi Moses Avigdor Chaikin. Memorial Sermon ... at the Great Synagogue, London, Thursday, June 28th, 1928

Joseph Herman Hertz

The great fluid debate: saline or so-called "balanced" salt solutions?

BACKGROUND Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians. RESULTS As compared with so-called "balanced" salt crystalloids such as lactated Ringer, administration of large volumes of 0.9 % saline has been associated with following deleterious effects: tendency to hyperchloremic metabolic acidosis (called dilution acidosis); acute kidney injury with reduced urine output and salt retention; damaged vascular permeability and stiffness, increase in proinflammatory mediators; detrimental effect on coagulation with tendency to blood loss; detrimental gastrointestinal perfusion and function; possible uneasiness at the bedside resulting in unnecessary administration of more fluids. Nevertheless, there is no firm evidence that these adverse effects are clinically relevant. CONCLUSIONS Intravenous fluid therapy is a medicine like insulin, chemotherapy or antibiotics. Prescribing fluids should fit the child's history and condition, consider the right dose at the right rate as well as the electrolyte levels and other laboratory variables. It is unlikely that a single type of fluid will be suitable for all pediatric patients. "Balanced" salt crystalloids, although more expensive, should be preferred for volume resuscitation, maintenance and perioperatively. Lactated Ringer appears unsuitable for patients at risk for brain edema and for those with overt or latent chloride-deficiency. Finally, in pediatrics there is a need for new fluids to be developed on the basis of a better understanding of the physiology and to be tested in well-designed trials.

Identification and analysis of novel mitotic inhibitors of the Caenorhabditis elegans Aurora B kinase

Proper execution of mitosis requires the accurate segregation of replicated DNA into each daughter cell. The highly conserved mitotic kinase AIR-2/Aurora B is a dynamic protein that interacts with subsets of cofactors and substrates to coordinate chromosome segregation and cytokinesis in Caenorhabdiris elegans. To identify components of the AIR-2 regulatory pathway, a genome-wide RNAi-based screen for suppressors of air-2 temperature-sensitive mutant lethality was conducted. Here, I present evidence that two classes of suppressors identified in this screen are bona fide regulators of the AIR-2 kinase. The strongest suppressor cdc-48.3, encodes an Afg2/Spaf-related Cdc48-like AAA+ ATPase that regulates AIR-2 kinase activity and stability during C. elegans embryogenesis. Loss of CDC-48.3 suppresses the lethality of air-2 mutant embryos, marked by the restoration of the dynamic behavior of AIR-2 and rescue of chromosome segregation and cytokinesis defects. Loss of CDC-48.3 leads to mitotic delays and abnormal accumulation of AIR-2 during late telophase/mitotic exit. In addition, AIR-2 kinase activity is significantly upregulated from metaphase through mitotic exit in CDC-48.3 depleted embryos. Inhibition of the AIR-2 kinase is dependent on (1) a direct physical interaction between CDC-48.3 and AIR-2, and (2) CDC-48.3 ATPase activity. Importantly, the increase in AIR-2 kinase activity does not correlate with the stabilization of AIR-2 in late mitosis. Hence, CDC-48.3 is a bi-functional inhibitor of AIR-2 that is likely to act via distinct mechanisms. The second class of suppressors consists of psy-2/smk-1 and pph-4.1, which encode two components of the conserved PP4 phosphatase complex that is essential for spindle assembly, chromosome segregation, and overall mitotic progression. AIR-2 and its substrates are likely to be targets of this complex since mitotic AIR-2 kinase activity is significantly increased during mitosis when either PSY-2/SMK-1 or PPH-4.l is depleted. Altogether, this study demonstrates that during the C. elegans embryonic cell cycle, regulators including the CDC-48.3 ATPase and PP4 phosphatase complex interact with and control the kinase activity, targeting behavior and protein stability of the Aurora B kinase to ensure accurate and timely progression of mitosis. ^

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.

Rendición o Resistencia? : El primer discurso latino

En la segunda mitad del siglo IV a. C. Roma ocupa la Italia central y se orienta al dominio de la región meridional en colisión posible con griegos y cartagineses; su influjo se extiende incluso al Jónico cuando varias ciudades de la Magna Grecia solicitan su protección, no así Tarento, que al anclar una escuadra romana en su puerto, reaccionó atacando las naves y una guarnición romana próxima. Tarento, ante una guerra inevitable, pidió apoyo al rey Pirro de Epiro, quien vio la oportunidad de extender hacia occidente las conquistas que Alejandro dejó inconclusas; su invasión de Italia generó fuerte resistencia, pero no le impidió victorias costosas ni su avance hacia el norte; propuso por intermedio de un embajador la rendición y condiciones gravosas para los romanos que estuvieron a punto de ceder. Allí surge Appio Claudia el Ciego, anciano senador ya retirado, que con un discurso breve, preciso y muy logrado produjo un giro en las decisiones de los patricios. Analizamos el discurso conservado por Plutarco en la Vida de Pirro y lo ubicamos dentro de su contexto histórico y político; gracias a él, Roma conservó sus fronteras itálicas y preparó su futura expansión.

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.

Rendición o Resistencia? : El primer discurso latino

En la segunda mitad del siglo IV a. C. Roma ocupa la Italia central y se orienta al dominio de la región meridional en colisión posible con griegos y cartagineses; su influjo se extiende incluso al Jónico cuando varias ciudades de la Magna Grecia solicitan su protección, no así Tarento, que al anclar una escuadra romana en su puerto, reaccionó atacando las naves y una guarnición romana próxima. Tarento, ante una guerra inevitable, pidió apoyo al rey Pirro de Epiro, quien vio la oportunidad de extender hacia occidente las conquistas que Alejandro dejó inconclusas; su invasión de Italia generó fuerte resistencia, pero no le impidió victorias costosas ni su avance hacia el norte; propuso por intermedio de un embajador la rendición y condiciones gravosas para los romanos que estuvieron a punto de ceder. Allí surge Appio Claudia el Ciego, anciano senador ya retirado, que con un discurso breve, preciso y muy logrado produjo un giro en las decisiones de los patricios. Analizamos el discurso conservado por Plutarco en la Vida de Pirro y lo ubicamos dentro de su contexto histórico y político; gracias a él, Roma conservó sus fronteras itálicas y preparó su futura expansión.

Tramas intergenéricas en el relato Lucaniano del 'día después' (B.C., VII, 786-846)

La escena del campo de batalla tras el enfrentamiento entre pompeyanos y cesarianos en el libro VII del Bellum Ciuile de Lucano (786-846) deja al descubierto el proceso de refuncionalización del tópico tradicional del día después de la lucha. Desde una perspectiva estilística mostramos que la intersección entre los códigos historiográfico, épico y trágico y la manipulación de diversos motivos literarios y culturales en dicho relato pueden leerse como uno de los principales mecanismos de la poética lucaniana del ciuile nefas.