Use of Short-term Circulatory Support as a Bridge in Pediatric Heart Transplantation

Background:Heart transplantation is considered the gold standard therapy for the advanced heart failure, but donor shortage, especially in pediatric patients, is the main limitation for this procedure, so most sick patients die while waiting for the procedure.Objective:To evaluate the use of short-term circulatory support as a bridge to transplantation in end-stage cardiomyopathy.Methods:Retrospective clinical study. Between January 2011 and December 2013, 40 patients with cardiomyopathy were admitted in our Pediatric Intensive Care Unit, with a mean age of 4.5 years. Twenty patients evolved during hospitalization with clinical deterioration and were classified as Intermacs 1 and 2. One patient died within 24 hours and 19 could be stabilized and were listed. They were divided into 2 groups: A, clinical support alone and B, implantation of short-term circulatory support as bridge to transplantation additionally to clinical therapy.Results:We used short-term mechanical circulatory support as a bridge to transplantation in 9. In group A (n=10), eight died waiting and 2 patients (20%) were transplanted, but none was discharged. In group B (n=9), 6 patients (66.7%) were transplanted and three were discharged.The mean support time was 21,8 days (6 to 984h). The mean transplant waiting list time was 33,8 days. Renal failure and sepsis were the main complication and causeof death in group A while neurologic complications were more prevalent en group B.Conclusion:Mechanical circulatory support increases survival on the pediatric heart transplantation waiting list in patients classified as Intermacs 1 and 2.

Fishes of the Crane Pacific expedition, by Albert W. Herre.

v.21(1936)

Notes on New Guinean crocodiles, by Karl P. Schmidt. Reports on results of the Crane Pacific expedition.

v.18:no.8(1932)

Birds of the Crane Pacific expedition, by Ernst Mayr and Sidney Camras.

v.20:no.34(1938)

New fishes obtained by the Crane Pacific expedition, by Albert W. Herre.

v.18:no.12(1935)

Reptiles and amphibians from the Solomon Islands, by Karl P. Schmidt. Reports on results of the Crane Pacific expedition.

v.18:no.9(1932)

When ESDP confronts ENP: security sector reform as a bridge in the EU’s foreign policy

The European Neighbourhood Policy’s birth has taken place in parallel with the renewed momentum of the European Security and Defence Policy, which has launched 14 operations since 2003. Both policies’ instruments have converged in the neighbouring area covered by ENP: Georgia, in the East and the Palestinian Territories in the South. In both cases, the Security Sector Reform strategies have been the main focus for ESDP and an important objective for ENP. In this paper, two objectives are pursued: first, to assess the EU’s involvement in both cases in SSR terms; and second, to analyse whether the convergence of ESDP operations with a broader EU neighbourhood policy implies that the former has become an instrument for the a EU external action.

Estimation of electronic coupling in π -stacked donor-bridge-acceptor systems: correction of the two-state model

Comparison of donor-acceptor electronic couplings calculated within two-state and three-state models suggests that the two-state treatment can provide unreliable estimates of Vda because of neglecting the multistate effects. We show that in most cases accurate values of the electronic coupling in a π stack, where donor and acceptor are separated by a bridging unit, can be obtained as Ṽ da = (E2 - E1) μ12 Rda + (2 E3 - E1 - E2) 2 μ13 μ23 Rda2, where E1, E2, and E3 are adiabatic energies of the ground, charge-transfer, and bridge states, respectively, μij is the transition dipole moments between the states i and j, and Rda is the distance between the planes of donor and acceptor. In this expression based on the generalized Mulliken-Hush approach, the first term corresponds to the coupling derived within a two-state model, whereas the second term is the superexchange correction accounting for the bridge effect. The formula is extended to bridges consisting of several subunits. The influence of the donor-acceptor energy mismatch on the excess charge distribution, adiabatic dipole and transition moments, and electronic couplings is examined. A diagnostic is developed to determine whether the two-state approach can be applied. Based on numerical results, we showed that the superexchange correction considerably improves estimates of the donor-acceptor coupling derived within a two-state approach. In most cases when the two-state scheme fails, the formula gives reliable results which are in good agreement (within 5%) with the data of the three-state generalized Mulliken-Hush model

Investigation of the Modified Beam-in-Slab Bridge System, Technical Report, 2004, Vol. 1

Technical Report